MEDICARE: DR. DOMINGO NGO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	ME31224	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902866213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOMINGO NGO MD

Provider Business Mailing Address
First Line	:	PO BOX 417
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34995-0417
Country	:	US
Telephone Number	:	772-223-5665
Fax Number	:	772-223-8546

Provider Business Practice Location Address
First Line	:	823 SE OSCEOLA ST
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-2431
Country	:	US
Telephone Number	:	772-283-9111
Fax Number	:	772-283-2955

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	01/14/2014

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Directions to “ DR. DOMINGO NGO MD” Practice Location

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