MEDICARE: DR. VINCENT TAM NGUYEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD200621	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	248568YRBU	OTHER	LA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053459644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT TAM NGUYEN MD

Provider Business Mailing Address
First Line	:	8490 PICARDY AVE
Second Line	:	BLDG 200
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-3731
Country	:	US
Telephone Number	:	225-237-1754
Fax Number	:	225-237-1722

Provider Business Practice Location Address
First Line	:	17520 OLD JEFFERSON HWY
Second Line	:	STE B
City	:	PRAIRIEVILLE
State	:	LA
Zip	:	70769-3929
Country	:	US
Telephone Number	:	225-673-8983
Fax Number	:	225-677-8983

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2007
Last Update Date	:	09/24/2014

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Directions to “ DR. VINCENT TAM NGUYEN MD” Practice Location

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