Provider Demographics
NPI:1356374946
Name:LU, NAM-PHUONG T (DO)
Entity type:Individual
Prefix:
First Name:NAM-PHUONG
Middle Name:T
Last Name:LU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:619 S MARION AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-5808
Mailing Address - Country:US
Mailing Address - Phone:352-376-1611
Mailing Address - Fax:
Practice Address - Street 1:6484 FORT CAROLINE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-2042
Practice Address - Country:US
Practice Address - Phone:904-744-7300
Practice Address - Fax:904-722-4271
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS8549207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH66795Medicare UPIN
FL17305YMedicare PIN