Provider Demographics
NPI:1164621314
Name:VU, HOANG T (DO)
Entity Type:Individual
Prefix:DR
First Name:HOANG
Middle Name:T
Last Name:VU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 SW PERIMETER GLN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-0497
Mailing Address - Country:US
Mailing Address - Phone:386-719-9663
Mailing Address - Fax:386-719-9662
Practice Address - Street 1:440 SW PERIMETER GLN
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-0497
Practice Address - Country:US
Practice Address - Phone:386-719-9663
Practice Address - Fax:386-719-9662
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS111912081P2900X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS11191OtherMEDICL LICENSE
FL013362500Medicaid
FL14AF5OtherBSBS
FLEO056ZMedicare PIN
CA20A9901OtherMEDICAL LICENSE
W20A9901BMedicare PIN