Provider Demographics
NPI:1518042134
Name:POOLE, JEFFREY C (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:POOLE
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 1:111 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:SUITE #406
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-3028
Mailing Address - Country:US
Mailing Address - Phone:504-838-8225
Mailing Address - Fax:504-838-8233
Practice Address - Street 1:111 VETERANS MEMORIAL BLVD
Practice Address - Street 2:SUITE #406
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-3028
Practice Address - Country:US
Practice Address - Phone:504-838-8225
Practice Address - Fax:504-838-8233
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.021909207N00000X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1576387Medicaid
H52030Medicare UPIN
LA1576387Medicaid