Provider Demographics
NPI:1982628715
Name:NGUYEN, HIEU TRAC (MD)
Entity Type:Individual
Prefix:
First Name:HIEU
Middle Name:TRAC
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 1:499 N STATE ROAD 434
Mailing Address - Street 2:1011
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2142
Mailing Address - Country:US
Mailing Address - Phone:407-788-8118
Mailing Address - Fax:407-788-8488
Practice Address - Street 1:499 N STATE ROAD 434
Practice Address - Street 2:1011
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2142
Practice Address - Country:US
Practice Address - Phone:407-788-8118
Practice Address - Fax:407-788-8488
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44030207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E59522Medicare UPIN