Healthcare Provider Details

I. General information

NPI: 1851577415
Provider Name (Legal Business Name): DZUY LE MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 CORAL SANDS DR SUITE B
ROCKLEDGE FL
32955-2749
US

IV. Provider business mailing address

150 N SYKES CREEK PKWY # 300
MERRITT ISLAND FL
32953-3488
US

V. Phone/Fax

Practice location:
  • Phone: 321-690-0709
  • Fax: 321-690-0976
Mailing address:
  • Phone: 321-449-4168
  • Fax: 321-449-4164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME79752
License Number StateFL

VIII. Authorized Official

Name: SANDI LAROCHE
Title or Position: MSO CREDENTIALING COORDINATOR
Credential:
Phone: 321-449-4168