Provider Demographics
NPI:1063099281
Name:NGUYEN, DIEM-PHUC TRAN (MD)
Entity type:Individual
Prefix:
First Name:DIEM-PHUC
Middle Name:TRAN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:2839 HENLEY RD
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-9535
Practice Address - Country:US
Practice Address - Phone:904-376-4950
Practice Address - Fax:904-618-2183
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2024-07-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME164846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine