Provider Demographics
NPI:1992797575
Name:NGUYEN, BINH PHUC (MD)
Entity type:Individual
Prefix:
First Name:BINH
Middle Name:PHUC
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 1:4913 KENNEDY ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-1034
Mailing Address - Country:US
Mailing Address - Phone:504-454-0118
Mailing Address - Fax:504-456-5082
Practice Address - Street 1:4228 HOUMA BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-3000
Practice Address - Country:US
Practice Address - Phone:504-456-5131
Practice Address - Fax:504-456-5082
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05939R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3960460001OtherCIGNA
LA1946095Medicaid
LA1349526Medicaid
LA0690612OtherAETNA PROVIDER #
LA1349526Medicaid
LA1946095Medicaid
LA5F615Medicare ID - Type UnspecifiedGROUP MEDICARE #