Individual
MR. TAN PHUONG CAO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7487 S STATE ROAD 121, MACCLENNY, FL 32063-5451
(904) 259-6211
(904) 259-7104
Mailing address
7487 S STATE ROAD 121, MACCLENNY, FL 32063-5451
(904) 259-6211
(904) 259-7104
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME 45087
FL
Other
Enumeration date
08/28/2006
Last updated
07/08/2007
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