1992797575 NPI number — BINH PHUC NGUYEN MD

Table of content: LAURA L FERRE (NPI 1114790847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992797575 NPI number — BINH PHUC NGUYEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NGUYEN
Provider First Name:
BINH
Provider Middle Name:
PHUC
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992797575
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4913 KENNEDY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70006-1034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-454-0118
Provider Business Mailing Address Fax Number:
504-456-5082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4228 HOUMA BLVD
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70006-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-456-5131
Provider Business Practice Location Address Fax Number:
504-456-5082
Provider Enumeration Date:
08/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  05939R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3960460001 . This is a "CIGNA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1946095 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1349526 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0690612 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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