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General NPI Number Information
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NPI Number | 1730255696
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Entity Type | Individual
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Provider Name | RANDALL C POCHE M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 06/13/2017
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Provider Practice Location Address
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Address Line | 1645 LUTCHER AVE
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City | LUTCHER
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State | LA
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Zip | 70071-5150
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Country | US
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Telephone | 225-869-3493
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Fax | 225-869-9333
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Provider Business Mailing Address
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Address Line | 1645 LUTCHER AVE
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City | LUTCHER
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State | LA
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Zip | 70071-5150
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Country | US
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Telephone | 225-869-3493
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Fax | 225-869-9333
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | LA16676
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License Number State | LA
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