=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841563459
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANN E VOCKROTH MD A PROFESSIONAL MEDICAL CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2012
-----------------------------------------------------
Last Update Date | 03/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2600 BELLE CHASSE HWY SUITE 204
-----------------------------------------------------
City | TERRYTOWN
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70056-7156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-391-9249
-----------------------------------------------------
Fax | 504-394-5970
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2600 BELLE CHASSE HWY SUITE 204
-----------------------------------------------------
City | TERRYTOWN
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70056-7156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-391-9249
-----------------------------------------------------
Fax | 504-394-5970
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ANN VOCKROTH
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 504-391-9249
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207K00000X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology Physician
-----------------------------------------------------
License Number | 10426R
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------