Individual
DR. THANH DAI VO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2520 BERT KOUNS INDUSTRIAL LOOP, SUITE 105, SHREVEPORT, LA 71118-3130
(318) 212-5520
(318) 212-5540
Mailing address
2520 BERT KOUNS, STE 102, SHREVEPORT, LA 71118-3130
(318) 212-5972
(318) 212-5369
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD.200321
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1056502
—
LA
01
—
4J956
MEDICARE PTAN
LA
Enumeration date
07/10/2006
Last updated
07/20/2015
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