Provider Demographics
NPI:1922209675
Name:NGUYEN, QUANG THANH (MD)
Entity Type:Individual
Prefix:
First Name:QUANG
Middle Name:THANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4881 NW 8TH AVE
Mailing Address - Street 2:SUITE
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4582
Mailing Address - Country:US
Mailing Address - Phone:352-373-6338
Mailing Address - Fax:352-373-6144
Practice Address - Street 1:3305 SW 34TH CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-6616
Practice Address - Country:US
Practice Address - Phone:352-401-7575
Practice Address - Fax:352-401-7577
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME109477208100000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003752401Medicaid
FLFA025ZMedicare PIN