Provider Demographics
NPI:1992772263
Name:POCHE, MAHLON PAUL JR (MD)
Entity type:Individual
Prefix:DR
First Name:MAHLON
Middle Name:PAUL
Last Name:POCHE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MAHLON
Other - Middle Name:
Other - Last Name:POCHE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3131 NORTH I-10 SERVICE ROAD EAST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-0000
Mailing Address - Country:US
Mailing Address - Phone:504-833-7770
Mailing Address - Fax:504-833-7796
Practice Address - Street 1:3131 NORTH I-10 SERVICE ROAD EAST
Practice Address - Street 2:SUITE 308
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-0000
Practice Address - Country:US
Practice Address - Phone:504-833-7770
Practice Address - Fax:504-833-7796
Is Sole Proprietor?:No
Enumeration Date:2006-03-04
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.021487207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1929239Medicaid
LA1929239Medicaid
LA5N956Medicare ID - Type Unspecified