Healthcare Provider Details

I. General information

NPI: 1548328115
Provider Name (Legal Business Name): JALAL JOUDEH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W 4TH ST
DEQUINCY LA
70633-3301
US

IV. Provider business mailing address

PO BOX 866
DEQUINCY LA
70633-0866
US

V. Phone/Fax

Practice location:
  • Phone: 337-786-6161
  • Fax: 337-786-7999
Mailing address:
  • Phone: 337-786-6161
  • Fax: 337-786-7999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1445347
License Number StateLA

VIII. Authorized Official

Name: DR. JALAL JOUDEH
Title or Position: OWNER
Credential: M.D.
Phone: 337-786-6161