Healthcare Provider Details

I. General information

NPI: 1699779389
Provider Name (Legal Business Name): HIEN DAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 07/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MAR WALT DR
FORT WALTON BEACH FL
32547-6708
US

IV. Provider business mailing address

1000 MAR WALT DR
FORT WALTON BEACH FL
32547-6708
US

V. Phone/Fax

Practice location:
  • Phone: 850-315-4249
  • Fax: 866-315-4258
Mailing address:
  • Phone: 850-315-4249
  • Fax: 866-315-4258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME79705
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME79705
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: