Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 6103 | LA |
Y | 213EG0000X | General Practice | 6103 | LA |
NPI | 1003121591 |
---|---|
Provider Name | Thai Quoc Nguyen |
First Address | Metairie, LA 70002-4343 |
Second Address | Metairie, LA 70001-3418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2010 |
Last Update Date | 12/12/2012 |