Healthcare Provider Details

I. General information

NPI: 1902877566
Provider Name (Legal Business Name): D VANG DPM APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W 21ST AVE
COVINGTON LA
70433
US

IV. Provider business mailing address

1010 W 21ST AVE
COVINGTON LA
70433
US

V. Phone/Fax

Practice location:
  • Phone: 985-893-3524
  • Fax: 985-893-9877
Mailing address:
  • Phone: 985-893-3524
  • Fax: 985-893-9877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDPM200001
License Number StateLA

VIII. Authorized Official

Name: DR. DAVID VANG
Title or Position: PHYSICIAN
Credential: DPM
Phone: 985-893-3524