Healthcare Provider Details

I. General information

NPI: 1750011276
Provider Name (Legal Business Name): MARIA FRANCES VONGVIPHUT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 HARRISON AVE.
PANAMA CITY FL
32405
US

IV. Provider business mailing address

1940 HARRISON AVE.
PANAMA CITY FL
32405
US

V. Phone/Fax

Practice location:
  • Phone: 850-763-0017
  • Fax:
Mailing address:
  • Phone: 850-763-0017
  • Fax: 850-692-5862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS23551
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: