Provider Demographics
NPI:1356376818
Name:NGUYEN, DZUNG (MD)
Entity type:Individual
Prefix:DR
First Name:DZUNG
Middle Name:
Last Name:NGUYEN
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 1:2007 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4545
Mailing Address - Country:US
Mailing Address - Phone:850-769-5224
Mailing Address - Fax:850-769-4515
Practice Address - Street 1:2007 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4545
Practice Address - Country:US
Practice Address - Phone:850-769-5224
Practice Address - Fax:850-769-4515
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067893207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593450313OtherPROVIDER FOR COMMERCIAL
FL397141600Medicaid
FLG12843Medicare UPIN
FL397141600Medicaid
FL27510BMedicare PIN