Provider Demographics
NPI:1629006812
Name:LE, DZUY VU (MD)
Entity Type:Individual
Prefix:
First Name:DZUY
Middle Name:VU
Last Name:LE
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 1:1004 BEVERLY DR STE A
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2851
Mailing Address - Country:US
Mailing Address - Phone:321-637-2954
Mailing Address - Fax:321-637-2654
Practice Address - Street 1:1004 BEVERLY DR STE A
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2851
Practice Address - Country:US
Practice Address - Phone:321-637-2954
Practice Address - Fax:321-637-2654
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL91547208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280190600Medicaid
FL50326ZMedicare ID - Type Unspecified
FL280190600Medicaid