Provider Demographics
NPI:1659644987
Name:NGUYEN VU, MD, PA
Entity Type:Organization
Organization Name:NGUYEN VU, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NGUYEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-506-3525
Mailing Address - Street 1:1656 S VOLUSIA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7335
Mailing Address - Country:US
Mailing Address - Phone:386-917-0007
Mailing Address - Fax:386-917-0089
Practice Address - Street 1:1656 S VOLUSIA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7335
Practice Address - Country:US
Practice Address - Phone:386-917-0007
Practice Address - Fax:386-917-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109751261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004451300Medicaid
FL005965200Medicaid
FL004451300Medicaid
FL6715210001Medicare NSC