Provider Demographics
NPI:1366547150
Name:NGUYEN, JOHN QUYET TU (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:QUYET TU
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 1:5410 MARYLAND WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5064
Mailing Address - Country:US
Mailing Address - Phone:615-377-5600
Mailing Address - Fax:
Practice Address - Street 1:2801 FRANCISCAN DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2544
Practice Address - Country:US
Practice Address - Phone:979-776-5967
Practice Address - Fax:979-774-4849
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3807207R00000X
CAG80554207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00466544OtherRR MEDICARE
TX1133860-05Medicaid
TX8V4242OtherBCBS TX
TX1366547150OtherSCOTT & WHITE HEALTH PLAN
TXP00466544Medicare PIN
G10944Medicare UPIN
TX1133860-05Medicaid