Provider Demographics
NPI:1194761510
Name:NGUYEN, LINH BAO (MD)
Entity type:Individual
Prefix:DR
First Name:LINH
Middle Name:BAO
Last Name:NGUYEN
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 1:5265 PARK BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-3451
Mailing Address - Country:US
Mailing Address - Phone:727-545-9590
Mailing Address - Fax:727-548-8590
Practice Address - Street 1:5265 PARK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3451
Practice Address - Country:US
Practice Address - Phone:727-545-9590
Practice Address - Fax:727-548-8590
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83186208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262389700Medicaid
FL03258Medicare ID - Type Unspecified