Provider Demographics
NPI:1336298439
Name:CHURCH, JOHN MARK JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARK
Last Name:CHURCH
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3525 PRYTANIA ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3500
Mailing Address - Country:US
Mailing Address - Phone:504-895-4561
Mailing Address - Fax:504-895-8529
Practice Address - Street 1:3525 PRYTANIA ST
Practice Address - Street 2:SUITE 230
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3500
Practice Address - Country:US
Practice Address - Phone:504-895-4561
Practice Address - Fax:504-895-8529
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
LAL010847208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery