Provider Demographics
NPI:1962511501
Name:QUAN, GANG (MD)
Entity type:Individual
Prefix:DR
First Name:GANG
Middle Name:
Last Name:QUAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 UNICORN LAKE BLVD
Mailing Address - Street 2:SUITE 152
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-0129
Mailing Address - Country:US
Mailing Address - Phone:214-394-6691
Mailing Address - Fax:940-898-8247
Practice Address - Street 1:3313 UNICORN LAKE BLVD
Practice Address - Street 2:SUITE 152
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-0129
Practice Address - Country:US
Practice Address - Phone:214-394-6691
Practice Address - Fax:940-898-8247
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4662207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151200603Medicaid
TX151200603Medicaid
BQ7830880OtherDEA
8C0524Medicare ID - Type Unspecified