MEDICARE: VINCENT GRAY VALENTINE 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	207RP1001X	Pulmonary Disease Physician	35304	AL
2	207RP1001X	Pulmonary Disease Physician	019633	LA
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	019633	LA
4	207R00000X	Internal Medicine Physician	132557	TX
5	207RP1001X	Pulmonary Disease Physician	41750	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00467144	OTHER	TX	RR MCR PTAN

General Provider Information

NPI Number	:	1972530608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT GRAY VALENTINE MD

Provider Business Mailing Address
First Line	:	5959 S SHERWOOD FOREST BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-6038
Country	:	US
Telephone Number	:	225-765-5864
Fax Number	:	225-765-9196

Provider Business Practice Location Address
First Line	:	7777 HENNESSY BLVD STE 409
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-4365
Country	:	US
Telephone Number	:	225-765-5864
Fax Number	:	225-765-2013

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

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	01/12/2023

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Directions to “ VINCENT GRAY VALENTINE MD” Practice Location

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