Provider Demographics
NPI:1093956518
Name:LOCOCO MEDICAL CONSULTANT
Entity Type:Organization
Organization Name:LOCOCO MEDICAL CONSULTANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:B
Authorized Official - Last Name:LOCOCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-375-3239
Mailing Address - Street 1:6759 N PARK CIR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-9128
Mailing Address - Country:US
Mailing Address - Phone:318-375-3239
Mailing Address - Fax:318-375-2755
Practice Address - Street 1:6759 N PARK CIR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-9128
Practice Address - Country:US
Practice Address - Phone:318-375-3239
Practice Address - Fax:318-375-2755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5U802Medicare PIN