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General NPI Number Information
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NPI Number | 1831415546
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Entity Type | Individual
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Provider Name | DUSTIN LUKE VINCENT M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/20/2010
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Last Update Date | 09/16/2013
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Provider Practice Location Address
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Address Line | 8460 HARRIS RD
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City | DENHAM SPRINGS
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State | LA
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Zip | 70726-6729
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Country | US
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Telephone | 225-665-5915
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Fax |
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Provider Business Mailing Address
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Address Line | 200 CORPORATE BLVD SUITE 201
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City | LAFAYETTE
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State | LA
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Zip | 70508-3870
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Country | US
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Telephone |
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD.206194
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License Number State | LA
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