Provider Demographics
NPI:1710962071
Name:NGUYEN, BAOLONG (MD)
Entity Type:Individual
Prefix:
First Name:BAOLONG
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8121 NATIONAL AVE
Mailing Address - Street 2:STE 303
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-7530
Mailing Address - Country:US
Mailing Address - Phone:405-737-4464
Mailing Address - Fax:405-737-7674
Practice Address - Street 1:8121 NATIONAL AVE
Practice Address - Street 2:STE 303
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-7530
Practice Address - Country:US
Practice Address - Phone:405-737-4464
Practice Address - Fax:405-737-7674
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23260207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H81461Medicare UPIN