Provider Demographics
NPI:1487834172
Name:LUANGPHAKDY, VANH (MD)
Entity Type:Individual
Prefix:DR
First Name:VANH
Middle Name:
Last Name:LUANGPHAKDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5831 BEE RIDGE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5088
Mailing Address - Country:US
Mailing Address - Phone:941-379-8481
Mailing Address - Fax:941-379-3781
Practice Address - Street 1:5831 BEE RIDGE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5088
Practice Address - Country:US
Practice Address - Phone:941-379-8481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001827207R00000X
FLME105678207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001556900Medicaid
FL146PTOtherBCBS OF FL
GAINT0000Medicare UPIN