Provider Demographics
NPI:1073826350
Name:PHU H NGUYEN DPM PA
Entity Type:Organization
Organization Name:PHU H NGUYEN DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HAYDEE
Authorized Official - Middle Name:I
Authorized Official - Last Name:MAYSONET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-854-6600
Mailing Address - Street 1:3661 S MIAMI AVE
Mailing Address - Street 2:SUITE # 309
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4236
Mailing Address - Country:US
Mailing Address - Phone:305-854-6600
Mailing Address - Fax:305-854-9777
Practice Address - Street 1:3661 S MIAMI AVE
Practice Address - Street 2:SUITE # 309
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4236
Practice Address - Country:US
Practice Address - Phone:305-854-6600
Practice Address - Fax:305-854-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3164213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
65931OtherBC BS FLA
FL340630000Medicaid
65931OtherBC BS FLA
FL340630000Medicaid