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General NPI Number Information
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NPI Number | 1518128438
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Entity Type | Organization
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Legal Business Name | ST. LUCIE GASTROINTESTINAL DISEASES PL
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | ELM AND CARLTON STREET
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City | BUFFALO
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State | NY
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Zip | 14263-0001
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Country | US
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Telephone | 716-845-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 430 CHANSLOR RD
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City | BRUNSWICK
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State | GA
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Zip | 31525-8707
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Country | US
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Telephone | 215-275-4598
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. KHIEM NGUYEN
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Credential | M.D.
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Telephone | 215-275-4598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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