Provider Demographics
NPI:1174656151
Name:NGUYEN, DAVID T (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6735 CROSSWINDS DR N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-5471
Mailing Address - Country:US
Mailing Address - Phone:727-548-8500
Mailing Address - Fax:727-501-7328
Practice Address - Street 1:6735 CROSSWINDS DR N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-5471
Practice Address - Country:US
Practice Address - Phone:727-548-8500
Practice Address - Fax:727-501-7328
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS-7942207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260837500Medicaid
FL58652OtherFLORIDA BLUE
FLH34092Medicare UPIN
FLBN6456657OtherDEA NUMBER