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General NPI Number Information
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NPI Number | 1821156878
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Entity Type | Organization
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Legal Business Name | SLIDELL FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1051 GAUSE BLVD SUITE 380
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City | SLIDELL
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State | LA
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Zip | 70458-2951
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Country | US
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Telephone | 985-641-8191
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Fax | 985-641-9812
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Provider Business Mailing Address
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Address Line | PO BOX 160
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City | SLIDELL
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State | LA
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Zip | 70459-0160
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Country | US
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Telephone | 985-641-8191
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Fax | 985-641-9812
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Authorized Official
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Title or Position | OWNER
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Name | DR. CUONG VAN LE
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Credential | M.D.
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Telephone | 985-641-8191
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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 | MD 06533R
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License Number State | LA
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