Provider Demographics
NPI:1841563459
Name:ANN E VOCKROTH MD A PROFESSIONAL MEDICAL CORP
Entity Type:Organization
Organization Name:ANN E VOCKROTH MD A PROFESSIONAL MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:VOCKROTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-391-9249
Mailing Address - Street 1:2600 BELLE CHASSE HWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7156
Mailing Address - Country:US
Mailing Address - Phone:504-391-9249
Mailing Address - Fax:504-394-5970
Practice Address - Street 1:2600 BELLE CHASSE HWY
Practice Address - Street 2:SUITE 204
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-7156
Practice Address - Country:US
Practice Address - Phone:504-391-9249
Practice Address - Fax:504-394-5970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10426R207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1991967Medicaid