Healthcare Provider Details

I. General information

NPI: 1013126127
Provider Name (Legal Business Name): DAVID NGUYEN D O PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 PARK BLVD
PINELLAS PARK FL
33781-3529
US

IV. Provider business mailing address

4640 PARK BLVD
PINELLAS PARK FL
33781-3529
US

V. Phone/Fax

Practice location:
  • Phone: 727-532-9906
  • Fax: 727-532-9769
Mailing address:
  • Phone: 727-532-9906
  • Fax: 727-532-9769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOS7942
License Number StateFL

VIII. Authorized Official

Name: DR. DAVID THANH NGUYEN
Title or Position: DOCTOR
Credential: D.O.
Phone: 727-532-9906