Provider Demographics
NPI:1396799771
Name:NGUYEN, HOA T (MD)
Entity type:Individual
Prefix:
First Name:HOA
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 89
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:71264
Mailing Address - Country:US
Mailing Address - Phone:318-396-2715
Mailing Address - Fax:318-397-4914
Practice Address - Street 1:309 JACKSON STREET
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-327-4000
Practice Address - Fax:318-397-4914
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2421207Q00000X
LAMD10662R207Q00000X
LAMD.10662R207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177350901Medicaid
LA1995541Medicaid
TXF88571Medicare UPIN
LAF88571Medicare UPIN
TX8G1088Medicare ID - Type Unspecified
LA1995541Medicaid
TX177350901Medicaid