Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 0966R | LA |
NPI | 1114975554 |
---|---|
Provider Name | Dr. Benjamin Bang V Nguyen |
First Address | Shreveport, LA 71105-5538 |
Second Address | Shreveport, LA 71105-5538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1981087 | (05) | LA |
F35071 | (02) | LA |