Provider Demographics
NPI:1164551909
Name:PORCHE, HEATHER CROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:CROSS
Last Name:PORCHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5135 CITRUS BLVD
Mailing Address - Street 2:APT # 164
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123-7104
Mailing Address - Country:US
Mailing Address - Phone:504-729-4071
Mailing Address - Fax:504-729-4071
Practice Address - Street 1:2017 METAIRIE RD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-3832
Practice Address - Country:US
Practice Address - Phone:504-832-8022
Practice Address - Fax:504-832-8044
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.200555208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1-07482-9Medicaid