Provider Demographics
NPI:1902877566
Name:D VANG DPM APMC
Entity Type:Organization
Organization Name:D VANG DPM APMC
Other - Org Name:AMBULATORY FOOT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:VANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:985-893-3524
Mailing Address - Street 1:1010 W 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433
Mailing Address - Country:US
Mailing Address - Phone:985-893-3524
Mailing Address - Fax:985-893-9877
Practice Address - Street 1:1010 W 21ST AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-893-3524
Practice Address - Fax:985-893-9877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADPM200001213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1479829Medicaid
LA1369683Medicaid
LADE0253OtherRAILROAD MEDICARE GROUP #
LA5CP84Medicare PIN
LADE0253OtherRAILROAD MEDICARE GROUP #