Healthcare Provider Details

I. General information

NPI: 1699773564
Provider Name (Legal Business Name): HUEY THE NGUYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 2ND AVE SW
LARGO FL
33770-2298
US

IV. Provider business mailing address

1301 2ND AVE SW
LARGO FL
33770-2298
US

V. Phone/Fax

Practice location:
  • Phone: 727-584-7706
  • Fax: 727-581-2786
Mailing address:
  • Phone: 727-584-7706
  • Fax: 727-581-2786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35.063641
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01055298A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME157741
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: