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General NPI Number Information
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NPI Number | 1548328115
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Entity Type | Organization
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Legal Business Name | JALAL JOUDEH
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 601 W 4TH ST
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City | DEQUINCY
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State | LA
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Zip | 70633-3301
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Country | US
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Telephone | 337-786-6161
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Fax | 337-786-7999
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Provider Business Mailing Address
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Address Line | PO BOX 866
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City | DEQUINCY
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State | LA
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Zip | 70633-0866
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Country | US
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Telephone | 337-786-6161
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Fax | 337-786-7999
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Authorized Official
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Title or Position | OWNER
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Name | DR. JALAL JOUDEH
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Credential | M.D.
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Telephone | 337-786-6161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 1445347
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License Number State | LA
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