Provider Demographics
NPI:1730324245
Name:LY, TAN DUY (DO)
Entity Type:Individual
Prefix:DR
First Name:TAN
Middle Name:DUY
Last Name:LY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5922 CATTLEMEN LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6204
Mailing Address - Country:US
Mailing Address - Phone:941-371-9773
Mailing Address - Fax:941-556-0343
Practice Address - Street 1:5922 CATTLEMEN LN STE 201
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6204
Practice Address - Country:US
Practice Address - Phone:941-371-9773
Practice Address - Fax:941-556-0341
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016546207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL148PPOtherBCBS FL PROVIDER NUMBER
FL1730324245OtherNPI