Provider Demographics
NPI:1942235528
Name:NGUYEN, RICHARD D (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8715 HENDERSON RD
Mailing Address - Street 2:REN 4, #237
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-1143
Mailing Address - Country:US
Mailing Address - Phone:813-206-7515
Mailing Address - Fax:
Practice Address - Street 1:8715 HENDERSON RD
Practice Address - Street 2:REN 4, #237
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-1143
Practice Address - Country:US
Practice Address - Phone:813-206-7515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85614207Q00000X
FLME105937207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70477FMedicaid
CA1942235528OtherCOMMHLTHCNTRS, SANTA MARIA NPI#
CAFHC70477FMedicaid
CA1942235528OtherCOMMHLTHCNTRS, SANTA MARIA NPI#
CAWA85614A - W1508Medicare PIN
FLCV165ZMedicare PIN