Provider Demographics
NPI:1871507400
Name:PHAM, LUAN MINH (MD)
Entity Type:Individual
Prefix:DR
First Name:LUAN
Middle Name:MINH
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9936 FLORIDA BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-1402
Mailing Address - Country:US
Mailing Address - Phone:225-927-8772
Mailing Address - Fax:225-927-3563
Practice Address - Street 1:9936 FLORIDA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-1402
Practice Address - Country:US
Practice Address - Phone:225-927-8772
Practice Address - Fax:225-927-3563
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2015-10-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA10055R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1988049Medicaid
LA1988049Medicaid