Provider Demographics
NPI:1972580744
Name:AN, THANG QUOC (DO)
Entity Type:Individual
Prefix:DR
First Name:THANG
Middle Name:QUOC
Last Name:AN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9540 WYNLAKES PL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8515
Mailing Address - Country:US
Mailing Address - Phone:334-281-1818
Mailing Address - Fax:334-281-1970
Practice Address - Street 1:820 W SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36105-3019
Practice Address - Country:US
Practice Address - Phone:334-281-1818
Practice Address - Fax:334-281-1970
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO448207Q00000X
ALDO-448207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL04-01038OtherUNITED HEALTHCARE
AL009913630Medicaid