Provider Demographics
NPI:1760402630
Name:BOCCHINI, JOSEPH ANTHONY JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:BOCCHINI
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 1:2032 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2123
Mailing Address - Country:US
Mailing Address - Phone:318-698-0035
Mailing Address - Fax:318-698-0078
Practice Address - Street 1:2032 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2123
Practice Address - Country:US
Practice Address - Phone:318-698-0035
Practice Address - Fax:318-698-0078
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03937R2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1171166Medicaid
LA5J243F600OtherMEDICARE - PTAN
LA1171166Medicaid