Provider Demographics
NPI:1659943546
Name:DUC NGUYEN PODIATRY LLC
Entity Type:Organization
Organization Name:DUC NGUYEN PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DUC
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-744-9584
Mailing Address - Street 1:7509 STATE ROAD 13 N
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-2230
Mailing Address - Country:US
Mailing Address - Phone:904-417-8894
Mailing Address - Fax:877-370-4468
Practice Address - Street 1:7509 STATE ROAD 13 N
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-2230
Practice Address - Country:US
Practice Address - Phone:904-417-8894
Practice Address - Fax:877-370-4468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2022-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric