Jacob Ly Duong, D.O.

Primary specialty

Aerospace Medicine PhysicianTaxonomy code 2083A0100X

License

OS11893 Issued in FL

Practice address

100 Brewster Blvd
Camp Lejeune, NC 28547-2575

Phone

(910) 449-6126

NPI assigned

Mar 8, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652832000000",
    "number": "1104957190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 BREWSTER BLVD",
            "city": "CAMP LEJEUNE",
            "state": "NC",
            "postal_code": "285472575",
            "telephone_number": "910-449-6126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BREWSTER BLVD",
            "city": "CAMP LEJEUNE",
            "state": "NC",
            "postal_code": "285472575",
            "telephone_number": "910-449-6126"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "220 Hovey Rd",
            "address_purpose": "LOCATION",
            "city": "Pensacola",
            "state": "FL",
            "postal_code": "325081044",
            "country_code": "US",
            "telephone_number": "850-452-2741",
            "fax_number": "850-452-3842",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1711 Doolittle Ave",
            "address_2": "navy air station, fw joint reserve base",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761271133",
            "country_code": "US",
            "telephone_number": "817-782-5923",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DUONG",
        "first_name": "JACOB",
        "middle_name": "LY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-08",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "FL",
            "license": "OS 11893",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS 11893",
            "primary": false
        },
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "FL",
            "license": "OS11893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adrienne D Dumas, RDH
• Brendon Earl Dumas, SOIDC
• Stephen Duncan, CRNA
• Brian Jefferson Dunford, DNP, CRNA
• Jessica Therese Dunham, PH.D.
• Ashlee Durand
• Korrice Willis Eason, RDH
• Spencer Eastman
• Seth William Ebers
• Regina Marie Edwards, L.C.S.W.

• Aerospace Medicine Physician in Camp Lejeune, NC
• Providers in Camp Lejeune, NC by specialty
• Aerospace Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.