Provider Demographics
NPI:1285691782
Name:NGUYEN, LAMVIEN QUOC (MD)
Entity type:Individual
Prefix:
First Name:LAMVIEN
Middle Name:QUOC
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:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32562-0699
Mailing Address - Country:US
Mailing Address - Phone:850-243-7788
Mailing Address - Fax:850-243-7738
Practice Address - Street 1:151 MARY ESTHER BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1972
Practice Address - Country:US
Practice Address - Phone:850-243-7788
Practice Address - Fax:850-243-7738
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82527174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51312OtherBLUE CROSS BLUE SHIELD
FL51312OtherBLUE CROSS BLUE SHIELD
51312ZMedicare ID - Type Unspecified