Provider Demographics
NPI:1336150945
Name:DANG, TAM QUANG (MD)
Entity Type:Individual
Prefix:DR
First Name:TAM
Middle Name:QUANG
Last Name:DANG
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:PO BOX 450185
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75045-0185
Mailing Address - Country:US
Mailing Address - Phone:214-358-3154
Mailing Address - Fax:214-358-3154
Practice Address - Street 1:2525 INWOOD RD STE 127
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7444
Practice Address - Country:US
Practice Address - Phone:214-358-3154
Practice Address - Fax:214-358-3154
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9876207L00000X, 208D00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035046401Medicaid
TX035046401Medicaid
TX00N58DMedicare PIN