Provider Demographics
NPI:1760401475
Name:JOHN GEORGE ROHEIM, M.D.,FAAP, APMC
Entity Type:Organization
Organization Name:JOHN GEORGE ROHEIM, M.D.,FAAP, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GRORGE
Authorized Official - Last Name:ROHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-643-4558
Mailing Address - Street 1:105 MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE 202A
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458
Mailing Address - Country:US
Mailing Address - Phone:985-643-4558
Mailing Address - Fax:985-649-0663
Practice Address - Street 1:105 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 202A
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:985-643-4558
Practice Address - Fax:985-649-0663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1933058Medicaid
LAF36324Medicare UPIN