Individual
CHINH VIEN VAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1005 MAR WALT DRIVE, IMMEDIATE CARE DEPARTMENT, FORT WALTON BEACH, FL 32547-6796
(850) 863-8219
(850) 863-8249
Mailing address
1005 MAR WALT DRIVE, IMMEDIATE CARE DEPARTMENT, FORT WALTON BEACH, FL 32547-6796
(850) 863-8219
(850) 863-8249
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME112971
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005580200
—
FL
01
—
14L8L
BCBSFL
FL
Enumeration date
09/15/2010
Last updated
06/27/2014
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