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General NPI Number Information
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NPI Number | 1164613535
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Entity Type | Individual
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Provider Name | HAU TRUNG LA MD
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Gender | Male
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 10/14/2019
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Provider Practice Location Address
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Address Line | 713B PRESIDENT PL
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City | SMYRNA
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State | TN
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Zip | 37167-5652
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Country | US
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Telephone | 615-930-2162
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Fax | 615-930-2163
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Provider Business Mailing Address
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Address Line | 205 5TH AVE E
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City | SPRINGFIELD
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State | TN
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Zip | 37172-2435
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Country | US
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Telephone | 615-384-7500
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Fax | 615-752-5738
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD42545
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License Number State | TN
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