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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