=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164551909
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER CROSS PORCHE M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2017 METAIRIE RD
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70005-3832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-832-8022
-----------------------------------------------------
Fax | 504-832-8044
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5135 CITRUS BLVD APT # 164
-----------------------------------------------------
City | RIVER RIDGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70123-7104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-729-4071
-----------------------------------------------------
Fax | 504-729-4071
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | MD.200555
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------