Basic Information
| Provider Information | |||||||||
| NPI: | 1972093573 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | THANH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28442 E RIVER RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | PERRYSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435512795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198747939 | ||||||||
| FaxNumber: | 4194795878 | ||||||||
| Practice Location | |||||||||
| Address1: | 28442 E RIVER RD | ||||||||
| Address2: | |||||||||
| City: | PERRYSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198747939 | ||||||||
| FaxNumber: | 4198736837 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2018 | ||||||||
| LastUpdateDate: | 06/15/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 07/02/2021 | ||||||||
| NPIReactivationDate: | 07/15/2021 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35.140798 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.