Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | OS11191 | FL |
NPI | 1164621314 |
---|---|
Provider Name | Dr. Hoang T Vu |
First Address | Lake City, FL 32025-0497 |
Second Address | Lake City, FL 32025-0497 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2007 |
Last Update Date | 29/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
013362500 | (05) | FL |
14AF5 | BSBS (01) | FL |
OS11191 | MEDICL LICENSE (01) | FL |