Provider Demographics
NPI:1962938308
Name:NGUYEN, QUANG BAO (MD)
Entity type:Individual
Prefix:
First Name:QUANG
Middle Name:BAO
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:608 NW 9TH ST STE 6210
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1069
Mailing Address - Country:US
Mailing Address - Phone:405-272-9641
Mailing Address - Fax:405-235-0738
Practice Address - Street 1:1000 N LEE AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1036
Practice Address - Country:US
Practice Address - Phone:405-272-9641
Practice Address - Fax:405-235-0738
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK33119207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology