Provider Demographics
NPI:1194741355
Name:POUW, VICTOR VINCENT (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:VINCENT
Last Name:POUW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1430 LINDBERG DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-8056
Mailing Address - Country:US
Mailing Address - Phone:985-781-7337
Mailing Address - Fax:
Practice Address - Street 1:27350 HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:LACOMBE
Practice Address - State:LA
Practice Address - Zip Code:70445-6403
Practice Address - Country:US
Practice Address - Phone:985-882-7077
Practice Address - Fax:985-882-7079
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14077R2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1100617Medicaid
LA1100617Medicaid
LAF88844Medicare UPIN