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Organization
ROBERT CHUONG DMD MD PA
Active
Organization
ROBERT CHUONG DMD MD PA
Active
Other names
TAMPA BAY MAXILLOFACIAL SURGERY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT CHUONG M.D., D.M.D. (PRESIDENT)
(727) 894-1442
Entity
Organization
Contact information
Practice address
2140 16TH ST N, ST PETERSBURG, FL 33704-3924
(727) 894-1442
Mailing address
2140 16TH ST N, ST PETERSBURG, FL 33704-3924
(727) 894-1442
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
ME46866
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
042348300
—
FL
01
—
17804
WELLCARE
FL
01
—
2139383
AETNA
FL
01
—
240631
AVMED
FL
01
—
84866
BLUE CROSS BLUE SHIELD
FL
Enumeration date
04/06/2007
Last updated
12/09/2011
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