Provider Demographics
NPI:1710121348
Name:NGUYEN, SON BINH (MD)
Entity Type:Individual
Prefix:
First Name:SON
Middle Name:BINH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 LAPALCO BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7369
Mailing Address - Country:US
Mailing Address - Phone:504-392-4114
Mailing Address - Fax:504-533-8622
Practice Address - Street 1:435 LAPALCO BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7369
Practice Address - Country:US
Practice Address - Phone:504-392-4114
Practice Address - Fax:504-533-8622
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.205430207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1883964Medicaid
MS06735723Medicaid
LA245897YWVQMedicare PIN