Basic Information
Provider Information | |||||||||
NPI: | 1164717104 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NGUYEN | ||||||||
FirstName: | PETER | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | NGUYEN | ||||||||
OtherFirstName: | DUNG | ||||||||
OtherMiddleName: | ANH | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 8333 N DAVIS HWY FL 4 | ||||||||
Address2: |   | ||||||||
City: | PENSACOLA | ||||||||
State: | FL | ||||||||
PostalCode: | 325146050 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8509697979 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 8333 N DAVIS HWY FL 4 | ||||||||
Address2: |   | ||||||||
City: | PENSACOLA | ||||||||
State: | FL | ||||||||
PostalCode: | 325146050 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8509697979 | ||||||||
FaxNumber: | 8504769352 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/17/2011 | ||||||||
LastUpdateDate: | 01/10/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/10/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 141579 | CA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | BP20046674 | TX | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RC0000X | 2019-02853 | NC | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | ME154217 | FL | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | ME154217 | FL | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
No ID Information.