Provider Demographics
NPI:1902979594
Name:HUYNH, BAO L (MD)
Entity Type:Individual
Prefix:
First Name:BAO
Middle Name:L
Last Name:HUYNH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3175 CITRUS TOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6885
Mailing Address - Country:US
Mailing Address - Phone:352-240-3812
Mailing Address - Fax:888-716-2003
Practice Address - Street 1:3175 CITRUS TOWER BLVD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6885
Practice Address - Country:US
Practice Address - Phone:352-240-3812
Practice Address - Fax:888-716-2003
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2020-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 101771207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000245300Medicaid