Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | DN10893 | FL |
Y | 204E00000X | Oral & Maxillofacial Surgeon | ME0046866 | FL |
NPI | 1558369678 |
---|---|
Provider Name | Dr. Robert Chuong |
First Address | St Petersburg, FL 33704-3924 |
Second Address | St Petersburg, FL 33704-3924 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 09/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
072216200 | (05) | FL |
84866 | BLUE CROSS (01) | FL |
B74250 | (02) | FL |