Provider Demographics
NPI:1558369678
Name:CHUONG, ROBERT (MD, DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:CHUONG
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 16TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-3924
Mailing Address - Country:US
Mailing Address - Phone:727-894-1442
Mailing Address - Fax:727-823-0466
Practice Address - Street 1:2140 16TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-3924
Practice Address - Country:US
Practice Address - Phone:727-894-1442
Practice Address - Fax:727-823-0466
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN108931223S0112X
FLME0046866204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL072216200Medicaid
FL84866OtherBLUE CROSS
FL072216200Medicaid
FL84866OtherBLUE CROSS