Healthcare Provider Details

I. General information

NPI: 1710286794
Provider Name (Legal Business Name): PONTCHARTRAIN CANCER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 LAKEVIEW CIR
COVINGTON LA
70433-7512
US

IV. Provider business mailing address

15752 MEDICAL ARTS PLAZA SUITE 101
HAMMOND LA
70403-1446
US

V. Phone/Fax

Practice location:
  • Phone: 985-875-1202
  • Fax: 985-875-1205
Mailing address:
  • Phone: 985-419-0025
  • Fax: 985-875-0035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number203749
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberRN083847-AP04197
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number22330
License Number StateLA

VIII. Authorized Official

Name: DR. DAVID NELSON OUBRE
Title or Position: M.D.,/ OWNER
Credential: M.D.,
Phone: 985-419-0025