Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 15910 | LA |
NPI | 1083677611 |
---|---|
Provider Name | Mr. Cong T Vo |
First Address | Lafayette, LA 70508 |
Second Address | Lafayette, LA 70503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 30/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1321915 | (05) | LA |