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Organization
INDIVIDUAL PROVIDER
Active
Organization
INDIVIDUAL PROVIDER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHUONG NGUYEN THAI M.D. (MAJOR)
(850) 883-9055
Entity
Organization
Contact information
Practice address
307 BOATNER ROAD SUITE 114, 96TH MEDICAL GROUP, EGLIN, FL 32542
(850) 883-8600
Mailing address
307 BOATNER ROAD SUITE 114, 96TH MEDICAL GROUP, EGLIN, FL 32542
(850) 883-8600
Taxonomy
Speciality
Code
Description
License number
State
286500000X
Military Hospital
Primary
—
NULL
Other
Enumeration date
08/09/2012
Last updated
09/14/2012
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