Provider Demographics
NPI:1518120005
Name:NGUYEN, LUONG P (MD)
Entity Type:Individual
Prefix:
First Name:LUONG
Middle Name:P
Last Name:NGUYEN
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 1:21205 OLEAN BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6756
Mailing Address - Country:US
Mailing Address - Phone:941-613-2800
Mailing Address - Fax:941-613-2801
Practice Address - Street 1:21205 OLEAN BLVD STE A
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6756
Practice Address - Country:US
Practice Address - Phone:941-613-2800
Practice Address - Fax:941-613-2801
Is Sole Proprietor?:No
Enumeration Date:2008-07-06
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2010-0296207RI0200X
FLME111876207R00000X
FLME 111876207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14N79OtherBCBS
FL023592100Medicaid