Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | ME0067893 | FL |
NPI | 1356376818 |
---|---|
Provider Name | Dr. Dzung Nguyen |
First Address | Panama City, FL 32405-4545 |
Second Address | Panama City, FL 32405-4545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 30/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
397141600 | (05) | FL |
593450313 | PROVIDER FOR COMMERCIAL (01) | FL |
G12843 | (02) | FL |