Provider Demographics
NPI:1801823778
Name:NGUYEN, PHU HOANG (DPM)
Entity Type:Individual
Prefix:
First Name:PHU
Middle Name:HOANG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3661 S MIAMI AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4236
Mailing Address - Country:US
Mailing Address - Phone:305-854-6600
Mailing Address - Fax:305-854-9777
Practice Address - Street 1:3661 S MIAMI AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4236
Practice Address - Country:US
Practice Address - Phone:305-854-6600
Practice Address - Fax:305-854-9777
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3164213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65931OtherBLUE CROSS BLUE SHIELD
FL65931XOtherMEDICARE
FLPO3164OtherLICENSE
P00317187Medicare PIN
FLV09536Medicare UPIN