1518917087 NPI number — TRI D NGUYEN M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518917087 NPI number — TRI D NGUYEN M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

NGUYEN

Provider First Name:

TRI

Provider Middle Name:

D

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1518917087

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/05/2014

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2234 COLONIAL BLVD

Provider Second Line Business Mailing Address:

ATTN: PAYER CONTRACTING & RELATIONS DEPT.

Provider Business Mailing Address City Name:

FORT MYERS

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

33907-1412

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

239-931-7342

Provider Business Mailing Address Fax Number:

239-931-7385

Provider First Line Business Practice Location Address:

6215 21ST AVE W

Provider Second Line Business Practice Location Address:

SUITE B

Provider Business Practice Location Address City Name:

BRADENTON

Provider Business Practice Location Address State Name:

FL

Provider Business Practice Location Address Postal Code:

34209-7819

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

941-795-2270

Provider Business Practice Location Address Fax Number:

941-795-7995

Provider Enumeration Date:

05/12/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0001X , with the licence number:  ME34708 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 41160 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 4499014 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: P01257641 . This is a "RAILROAD MCR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: P938704 . This is a "OPTIMUM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 39743100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 276514400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 3930481 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 41160 . This is a "BCBS OF FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: P102250 . This is a "FREEDOM HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 225138 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: P304597 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".