Healthcare Provider Details

I. General information

NPI: 1003820788
Provider Name (Legal Business Name): DR. HIEU VUONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 S SHERWOOD FOREST BLVD STE. 360
BATON ROUGE LA
70816-4361
US

IV. Provider business mailing address

3851 S SHERWOOD FOREST BLVD STE. 360
BATON ROUGE LA
70816-4361
US

V. Phone/Fax

Practice location:
  • Phone: 225-293-0068
  • Fax: 225-293-0018
Mailing address:
  • Phone: 225-293-0068
  • Fax: 225-293-0018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPD225R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: