Healthcare Provider Details

I. General information

NPI: 1194741355
Provider Name (Legal Business Name): VICTOR VINCENT POUW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27350 HIGHWAY 190
LACOMBE LA
70445-6403
US

IV. Provider business mailing address

1430 LINDBERG DR
SLIDELL LA
70458-8056
US

V. Phone/Fax

Practice location:
  • Phone: 985-882-7077
  • Fax: 985-882-7079
Mailing address:
  • Phone: 985-781-7337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number14077R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: