Provider Demographics
NPI:1922120179
Name:HEAD AND NECK ASSOCIATES OF BAY COUNTY, INC
Entity Type:Organization
Organization Name:HEAD AND NECK ASSOCIATES OF BAY COUNTY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:QUANG
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-769-0278
Mailing Address - Street 1:724 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4101
Mailing Address - Country:US
Mailing Address - Phone:850-769-0336
Mailing Address - Fax:850-769-6202
Practice Address - Street 1:724 W 19TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4101
Practice Address - Country:US
Practice Address - Phone:850-769-0336
Practice Address - Fax:850-769-6202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257724100Medicaid
FL257724100Medicaid