Provider Demographics
NPI:1053312223
Name:VERHULST, JOHN H (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:VERHULST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 54482
Mailing Address - Street 2:ATTN: MANAGED CARE DEPARTMENT
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70154-4482
Mailing Address - Country:US
Mailing Address - Phone:985-892-3766
Mailing Address - Fax:985-893-9567
Practice Address - Street 1:606 W 11TH AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-3630
Practice Address - Country:US
Practice Address - Phone:985-892-3766
Practice Address - Fax:985-893-9567
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL03978R208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1328928Medicaid
LA1328928Medicaid
LAB61431Medicare UPIN