Provider Demographics
NPI:1548328115
Name:JALAL JOUDEH
Entity type:Organization
Organization Name:JALAL JOUDEH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JALAL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOUDEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-786-6161
Mailing Address - Street 1:PO BOX 866
Mailing Address - Street 2:
Mailing Address - City:DEQUINCY
Mailing Address - State:LA
Mailing Address - Zip Code:70633-0866
Mailing Address - Country:US
Mailing Address - Phone:337-786-6161
Mailing Address - Fax:337-786-7999
Practice Address - Street 1:601 W 4TH ST
Practice Address - Street 2:
Practice Address - City:DEQUINCY
Practice Address - State:LA
Practice Address - Zip Code:70633-3301
Practice Address - Country:US
Practice Address - Phone:337-786-6161
Practice Address - Fax:337-786-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1445347207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1445347Medicaid
LA5CF25Medicare PIN