MEDICARE: LONG NGUYEN M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208D00000X	General Practice Physician	304941	LA

General Provider Information

NPI Number	:	1427438191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LONG NGUYEN M.D.

Provider Business Mailing Address
First Line	:	6307 MOSSWOOD DR
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71203-3217
Country	:	US
Telephone Number	:	985-232-0340
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 GENERAL DEGAULLE DR
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70114-8207
Country	:	US
Telephone Number	:	504-362-2829
Fax Number	:	504-362-2866

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

Provider Enumeration Date	:	06/08/2015
Last Update Date	:	05/11/2017

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