Healthcare Provider Details

I. General information

NPI: 1164429874
Provider Name (Legal Business Name): HUAN VU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N BONITA AVE
PANAMA CITY FL
32401-3623
US

IV. Provider business mailing address

PO BOX 11407
BIRMINGHAM AL
35246-0100
US

V. Phone/Fax

Practice location:
  • Phone: 888-313-5258
  • Fax: 205-313-5299
Mailing address:
  • Phone: 888-313-5258
  • Fax: 205-313-5299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME82406
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: