Provider Demographics
NPI:1033117791
Name:DUONG, TONG C (MD)
Entity type:Individual
Prefix:DR
First Name:TONG
Middle Name:C
Last Name:DUONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-4290
Mailing Address - Country:US
Mailing Address - Phone:850-647-8825
Mailing Address - Fax:850-248-8825
Practice Address - Street 1:1702 OHIO AVE
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-4290
Practice Address - Country:US
Practice Address - Phone:850-647-8825
Practice Address - Fax:850-248-8825
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80081208200000X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
593031310OtherFEDERAL TAX ID
E61788Medicare UPIN
FL10558AMedicare PIN