Provider Demographics
NPI:1265638167
Name:VU, VANCHI RONNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:VANCHI
Middle Name:RONNIE
Last Name:VU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RONNIE
Other - Middle Name:CHI
Other - Last Name:VU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:120 RUE DES CANNES
Mailing Address - Street 2:
Mailing Address - City:MAURICE
Mailing Address - State:LA
Mailing Address - Zip Code:70555-3467
Mailing Address - Country:US
Mailing Address - Phone:318-272-7941
Mailing Address - Fax:
Practice Address - Street 1:1718 N MARTIN LUTHER KING HWY
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-1351
Practice Address - Country:US
Practice Address - Phone:318-272-7926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA204351207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1007510Medicaid
LA1007510Medicaid
LA4Q8827460Medicare PIN