Provider Demographics
NPI:1518917087
Name:NGUYEN, TRI D (MD)
Entity Type:Individual
Prefix:
First Name:TRI
Middle Name:D
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:6215 21ST AVE W
Practice Address - Street 2:SUITE B
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-7819
Practice Address - Country:US
Practice Address - Phone:941-795-2270
Practice Address - Fax:941-795-7995
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME347082085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41160OtherBCBS
FL4499014OtherAETNA
FLP01257641OtherRAILROAD MCR
FLP938704OtherOPTIMUM
FL39743100Medicaid
FL276514400Medicaid
FL3930481OtherCIGNA
FL41160OtherBCBS OF FL
FLP102250OtherFREEDOM HEALTH
FL225138OtherAVMED
FLP304597Medicaid
FL41160TMedicare PIN
FL3930481OtherCIGNA
FLD62402Medicare UPIN
FL276514400Medicaid
FL41160SMedicare PIN
FLP938704OtherOPTIMUM
FLP304597Medicaid