Basic Information
| Provider Information | |||||||||
| NPI: | 1205067394 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VO | ||||||||
| FirstName: | PHU | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4423 GRIGGS RD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770212815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134290655 | ||||||||
| FaxNumber: | 7134290670 | ||||||||
| Practice Location | |||||||||
| Address1: | 4423 GRIGGS RD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770212815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134290655 | ||||||||
| FaxNumber: | 7134290670 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2009 | ||||||||
| LastUpdateDate: | 12/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | DPM.200033 | LA | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213E00000X | 3126 | TX | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 2317229 | 05 | LA | MEDICAID |