Provider Demographics
NPI:1871876169
Name:NGUYEN, QUAN BAO (MD)
Entity type:Individual
Prefix:DR
First Name:QUAN
Middle Name:BAO
Last Name:NGUYEN
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 1:2111 HOLLY HALL ST APT 1812
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-3953
Mailing Address - Country:US
Mailing Address - Phone:916-346-8673
Mailing Address - Fax:
Practice Address - Street 1:2111 HOLLY HALL ST APT 1812
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-3953
Practice Address - Country:US
Practice Address - Phone:916-346-8673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8697207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine