Provider Demographics
NPI:1558474254
Name:VALENTA, JEROME CLEMENT JR (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:CLEMENT
Last Name:VALENTA
Suffix:JR
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 1:1585 3RD ST
Mailing Address - Street 2:DPC BAYNE-JONES ARMY COMMUNITY HOSPITAL
Mailing Address - City:FORT POLK
Mailing Address - State:LA
Mailing Address - Zip Code:71459-5102
Mailing Address - Country:US
Mailing Address - Phone:337-531-7856
Mailing Address - Fax:
Practice Address - Street 1:1585 3RD ST
Practice Address - Street 2:DPC BAYNE-JONES ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT POLK
Practice Address - State:LA
Practice Address - Zip Code:71459-5102
Practice Address - Country:US
Practice Address - Phone:337-531-7856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4731174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist