Provider Demographics
NPI:1730507674
Name:BUI, PHUONG (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:PHUONG
Middle Name:
Last Name:BUI
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7864 93RD ST
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777-4022
Mailing Address - Country:US
Mailing Address - Phone:941-223-8552
Mailing Address - Fax:
Practice Address - Street 1:125 PATRICIA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-8100
Practice Address - Country:US
Practice Address - Phone:727-331-8740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107732363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical