Healthcare Provider Details

I. General information

NPI: 1427438191
Provider Name (Legal Business Name): LONG NGUYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 GENERAL DEGAULLE DR
NEW ORLEANS LA
70114-8207
US

IV. Provider business mailing address

6307 MOSSWOOD DR
MONROE LA
71203-3217
US

V. Phone/Fax

Practice location:
  • Phone: 504-362-2829
  • Fax: 504-362-2866
Mailing address:
  • Phone: 985-232-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number304941
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: