Individual
LOI T VU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7420 GUTHRIE DR N STE 105, SOUTHAVEN, MS 38671-5857
(662) 349-4321
(662) 349-3263
Mailing address
2527 CRANBERRY HWY, WAREHAM, MA 02571-1046
(800) 841-5200
(508) 273-1351
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
19928
MS
2085R0202X
Diagnostic Radiology Physician
MD028110
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00117025
—
MS
05
—
131186001
—
AR
05
—
208493304
—
MO
05
—
3802782
—
TN
Enumeration date
06/02/2006
Last updated
03/29/2023
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