Provider Demographics
NPI:1174539118
Name:LE, DUNG NGUYEN (MD)
Entity type:Individual
Prefix:DR
First Name:DUNG
Middle Name:NGUYEN
Last Name:LE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ZOOM
Other - Middle Name:
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 100371
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0371
Mailing Address - Country:US
Mailing Address - Phone:352-338-2195
Mailing Address - Fax:352-265-0627
Practice Address - Street 1:1550 S WATER ST
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-4511
Practice Address - Country:US
Practice Address - Phone:904-368-2480
Practice Address - Fax:904-368-2481
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62766207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F57335Medicare UPIN
FL18668ZMedicare ID - Type Unspecified