Provider Demographics
NPI:1841238128
Name:NGUYEN, NHAT QUANG (MD)
Entity Type:Individual
Prefix:
First Name:NHAT
Middle Name:QUANG
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 1:831 NW COUNCIL DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3721
Mailing Address - Country:US
Mailing Address - Phone:503-382-8100
Mailing Address - Fax:503-382-8120
Practice Address - Street 1:831 NW COUNCIL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3721
Practice Address - Country:US
Practice Address - Phone:503-381-8100
Practice Address - Fax:503-382-8120
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26622208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR240517Medicaid
WA8460693Medicaid
WAO209425OtherLABOR & IND
P00310634OtherRR MEDICARE
840700001OtherREGENCE
240517OtherCAREOREGON
P00310634OtherRR MEDICARE
240517OtherCAREOREGON
WAO209425OtherLABOR & IND