Healthcare Provider Details

I. General information

NPI: 1063525962
Provider Name (Legal Business Name): CANH JEFF V VO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3902 HIGHWAY 22
MANDEVILLE LA
70471-7330
US

IV. Provider business mailing address

3902 HIGHWAY 22
MANDEVILLE LA
70471-7330
US

V. Phone/Fax

Practice location:
  • Phone: 985-778-2420
  • Fax: 339-217-9850
Mailing address:
  • Phone: 985-778-2420
  • Fax: 339-217-9850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number325969
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number02626
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: