Provider Demographics
NPI:1821385592
Name:NGUYEN, TOMMY (MD)
Entity type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 S HIGLEY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-5045
Mailing Address - Country:US
Mailing Address - Phone:480-875-9456
Mailing Address - Fax:480-546-4446
Practice Address - Street 1:4653 S LAKESHORE DR STE 3
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7161
Practice Address - Country:US
Practice Address - Phone:480-456-8981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPME6158207Q00000X, 207QA0401X
AZ74905207Q00000X, 208D00000X, 208D00000X
MI4301510341207Q00000X, 207QA0401X
AZTHMD00139207QA0401X
AZ273694363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR72480OtherTRAINING PERMIT