Provider Demographics
NPI:1275732414
Name:DEERFIELD BEACH MEDICAL CLINIC, P.A.
Entity Type:Organization
Organization Name:DEERFIELD BEACH MEDICAL CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAM
Authorized Official - Middle Name:QUOC
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-725-8808
Mailing Address - Street 1:5300 W. HILLSBORO BLVD.
Mailing Address - Street 2:SUITE 216
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073
Mailing Address - Country:US
Mailing Address - Phone:954-725-8808
Mailing Address - Fax:954-725-8818
Practice Address - Street 1:5300 W. HILLSBORO BLVD.
Practice Address - Street 2:SUITE 216
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073
Practice Address - Country:US
Practice Address - Phone:954-725-8808
Practice Address - Fax:954-725-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0008287207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000107864OtherHUMANA PROVIDER NUMBER
FLH78725Medicaid
FL264678100Medicaid
FL51382OtherBLUE CROSS BLE SHIELD PRO
43340OtherNEIGBORHOOD HEALTH PROVID
145360OtherAETNA PRIVIDER NUMBER
289806OtherAVMED PROVIDER NUMBER
P2789955OtherOXFORD HEALTH PLANS PROVI
289806OtherAVMED PROVIDER NUMBER