Provider Demographics
NPI:1124097886
Name:NGUYENDUY, TUAN NMN (MD)
Entity type:Individual
Prefix:
First Name:TUAN
Middle Name:NMN
Last Name:NGUYENDUY
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 1:1718 LEXINGTON GREEN LN
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1018
Mailing Address - Country:US
Mailing Address - Phone:407-302-5520
Mailing Address - Fax:407-324-2896
Practice Address - Street 1:1718 LEXINGTON GREEN LN
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1018
Practice Address - Country:US
Practice Address - Phone:407-302-5520
Practice Address - Fax:864-542-1045
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15552208G00000X
FLME142633208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTL5083Medicaid
SC195808OtherMEDCOST
NC890586XMedicaid
SC4242025OtherAETNA
SCB744975019OtherMEDICARE PIN
NC890586XMedicaid
SC060014846Medicare PIN
SCB74497Medicare UPIN