Provider Demographics
NPI:1457791865
Name:NGUYEN, THANH BINH VU (DPM)
Entity Type:Individual
Prefix:DR
First Name:THANH BINH
Middle Name:VU
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 1:15001 NAPLES PL
Mailing Address - Street 2:NONE
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-2070
Mailing Address - Country:US
Mailing Address - Phone:813-340-2211
Mailing Address - Fax:
Practice Address - Street 1:13801 BRUCE B DOWNS BLVD STE 205
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3937
Practice Address - Country:US
Practice Address - Phone:813-971-4678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-29
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPR327390200000X
FLPO3771213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM2498OtherMEDICARE PTAN
FLM2475OtherMEDICARE GROUP PTAN
FLM2469OtherMEDICARE GROUP PTAN
FL019477500Medicaid
FLM2497OtherMEDICARE PTAN