Healthcare Provider Details

I. General information

NPI: 1104231968
Provider Name (Legal Business Name): ALEXANDER HOANG NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 SW 172ND AVE STE 405
MIRAMAR FL
33029-5614
US

IV. Provider business mailing address

1951 SW 172ND AVE STE 405
MIRAMAR FL
33029-5614
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-7700
  • Fax: 954-276-0175
Mailing address:
  • Phone: 954-265-7700
  • Fax: 954-276-0175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME127257
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME127257
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: