Provider Demographics
NPI:1093745648
Name:LOCOCO, VINCENT BRYAN (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:BRYAN
Last Name:LOCOCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 TRI STATE DR
Mailing Address - Street 2:
Mailing Address - City:SAREPTA
Mailing Address - State:LA
Mailing Address - Zip Code:71071-2826
Mailing Address - Country:US
Mailing Address - Phone:318-994-2266
Mailing Address - Fax:318-539-9177
Practice Address - Street 1:401 11TH ST NE
Practice Address - Street 2:
Practice Address - City:SPRINGHILL
Practice Address - State:LA
Practice Address - Zip Code:71075-4503
Practice Address - Country:US
Practice Address - Phone:318-539-1701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021984207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1999814Medicaid
AR143688001Medicaid
AR5H048F635Medicare PIN
193801Medicare Oscar/Certification
F92689Medicare UPIN
LA5U802C817Medicare PIN
AR5H048Medicare PIN
LA1999814Medicaid
LA5U802B464Medicare PIN
LA193476Medicare Oscar/Certification