Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS 11893 | FL |
N | 207Q00000X | Family Doctor | OS 11893 | FL |
NPI | 1104957190 |
---|---|
Provider Name | Jacob Ly Nguyen Duong |
First Address | Pensacola, FL 32508-1044 |
Second Address | Pensacola, FL 32508-1044 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 20/07/2020 |