Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | DPM.PD0105 | LA |
NPI | 1609034859 |
---|---|
Provider Name | Dr. Trucly Chung Vu |
First Address | Baton Rouge, LA 70806-1818 |
Second Address | Baton Rouge, LA 70806-1818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2008 |
Last Update Date | 23/05/2008 |