Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | OS17242 | FL |
NPI | 1255865622 |
---|---|
Provider Name | Huy Duc Nguyen |
First Address | Lutz, FL 33559 |
Second Address | Tampa, FL 33609-4039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2017 |
Last Update Date | 14/10/2020 |