Healthcare Provider Details

I. General information

NPI: 1356376818
Provider Name (Legal Business Name): DZUNG NGUYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 12/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 HARRISON AVE
PANAMA CITY FL
32405-4545
US

IV. Provider business mailing address

2007 HARRISON AVE
PANAMA CITY FL
32405-4545
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-5224
  • Fax: 850-769-4515
Mailing address:
  • Phone: 850-769-5224
  • Fax: 850-769-4515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME0067893
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: