MEDICARE: DR. JOHN VOCKROTH III M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	10349R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80756	OTHER	LA	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	F7245	OTHER	LA	BLUE CROSS

General Provider Information

NPI Number	:	1841282100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN VOCKROTH III M.D.

Provider Business Mailing Address
First Line	:	120 MEADOWCREST ST
Second Line	:	SUITE 120
City	:	GRETNA
State	:	LA
Zip	:	70056-5255
Country	:	US
Telephone Number	:	504-620-5661
Fax Number	:	504-620-5675

Provider Business Practice Location Address
First Line	:	120 MEADOWCREST ST
Second Line	:	SUITE 120
City	:	GRETNA
State	:	LA
Zip	:	70056-5255
Country	:	US
Telephone Number	:	504-620-5661
Fax Number	:	504-620-5675

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	03/13/2017

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