Provider Demographics
NPI:1881954469
Name:NGUYEN, MINH (MD)
Entity type:Individual
Prefix:
First Name:MINH
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 SW RAMSEY AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5535
Mailing Address - Country:US
Mailing Address - Phone:541-472-7810
Mailing Address - Fax:541-472-7811
Practice Address - Street 1:520 SW RAMSEY AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5535
Practice Address - Country:US
Practice Address - Phone:541-472-7810
Practice Address - Fax:541-472-7811
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015031854207Q00000X
WI4489-850207Q00000X
NC2020-01163207Q00000X
ORMD206288207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1881954469Medicaid
WI1881954469Medicaid
MOPENDINGOtherRR MEDICARE
ORMD206288OtherOREGON STATE BOARD