Provider Demographics
NPI:1750564886
Name:HIEU TRAC NGUYEN MD PA
Entity type:Organization
Organization Name:HIEU TRAC NGUYEN MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HIEU
Authorized Official - Middle Name:TRAC
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-788-8118
Mailing Address - Street 1:499 N SR 434
Mailing Address - Street 2:SUITE 1011
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2142
Mailing Address - Country:US
Mailing Address - Phone:407-788-8118
Mailing Address - Fax:407-788-8488
Practice Address - Street 1:499 N SR 434
Practice Address - Street 2:SUITE 1011
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2142
Practice Address - Country:US
Practice Address - Phone:407-788-8118
Practice Address - Fax:407-788-8488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44030261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE59522Medicare UPIN