Provider Demographics
NPI:1215109400
Name:LAM NGUYEN MD PMC
Entity type:Organization
Organization Name:LAM NGUYEN MD PMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-824-6835
Mailing Address - Street 1:1322 ELTON RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-4100
Mailing Address - Country:US
Mailing Address - Phone:337-824-6835
Mailing Address - Fax:337-824-8741
Practice Address - Street 1:1322 ELTON RD
Practice Address - Street 2:SUITE E
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-4100
Practice Address - Country:US
Practice Address - Phone:337-824-6835
Practice Address - Fax:337-824-8741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021553207R00000X
207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CE81Medicare PIN