Provider Demographics
NPI:1881874899
Name:NGUYEN, SON VAN (MD)
Entity type:Individual
Prefix:DR
First Name:SON
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2309 E MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4063
Mailing Address - Country:US
Mailing Address - Phone:337-364-3301
Mailing Address - Fax:337-364-9689
Practice Address - Street 1:2309 E MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4063
Practice Address - Country:US
Practice Address - Phone:337-364-3301
Practice Address - Fax:337-364-9689
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA202570207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1079847Medicaid