Provider Demographics
NPI:1225293442
Name:NGUYEN, ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10273 SW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-6507
Mailing Address - Country:US
Mailing Address - Phone:630-688-1240
Mailing Address - Fax:
Practice Address - Street 1:2699 STIRLING RD
Practice Address - Street 2:SUITE A301/302
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6517
Practice Address - Country:US
Practice Address - Phone:954-278-3890
Practice Address - Fax:954-251-1470
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3297213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH567ZMedicare PIN