Provider Demographics
NPI:1225065824
Name:DEGENHARDT, DAVID VINH (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:VINH
Last Name:DEGENHARDT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18607 AVENUE MONACO
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-5316
Mailing Address - Country:US
Mailing Address - Phone:813-455-1762
Mailing Address - Fax:
Practice Address - Street 1:18607 AVENUE MONACO
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-5316
Practice Address - Country:US
Practice Address - Phone:813-455-1762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11896207P00000X
SC1383207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00879460OtherRAILROAD MEDICARE
NC5916234Medicaid
SC013835Medicaid
SCAA54749068Medicare PIN
SCP00879460OtherRAILROAD MEDICARE