Doctor Name: | DR. TRUNG VAN LE |
NPI Number: | 1538355862 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | ME42181 |
Business Practice Address: | 7487 S State Road 121 Macclenny, FL - 320635451 |
Business Phone Number: | 9043965682 |
Business Fax Number: | 9043460864 |
Mailing Address: | 820 Prudential Dr Ste 713, JACKSONVILLE |
State: | FL |
Postal Code: | 322078209 |
Phone Number: | 9043965682 |
Fax Number: | 9043460864 |
NPI Enumeration Date: | 09/20/2007 |
NPI Last Update Date: | 09/20/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ME42181 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |