Individual
STEPHEN RANDOLPH VICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7777 HENNESSY BLVD, SUITE 2004, BATON ROUGE, LA 70808-4300
(225) 769-2500
(225) 769-9424
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(225) 526-0011
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
022020
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1537772
—
LA
Enumeration date
03/28/2006
Last updated
03/10/2021
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