Provider Demographics
NPI:1801278171
Name:NGUYEN, DUC (DPM)
Entity type:Individual
Prefix:DR
First Name:DUC
Middle Name:
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 1:7509 STATE ROAD 13 N
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-2230
Mailing Address - Country:US
Mailing Address - Phone:904-417-8894
Mailing Address - Fax:877-370-4468
Practice Address - Street 1:7509 STATE ROAD 13 N
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-2230
Practice Address - Country:US
Practice Address - Phone:904-417-8894
Practice Address - Fax:877-370-4468
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2022-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FL4126213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program