Provider Demographics
NPI:1245554278
Name:POUNDS, JERRY WAYNE JR
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:WAYNE
Last Name:POUNDS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:SUITE #404
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-3028
Mailing Address - Country:US
Mailing Address - Phone:504-899-1120
Mailing Address - Fax:504-899-2432
Practice Address - Street 1:111 VETERANS MEMORIAL BLVD
Practice Address - Street 2:SUITE #404
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-3028
Practice Address - Country:US
Practice Address - Phone:504-899-1120
Practice Address - Fax:504-899-2432
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LAMD.205282207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06838888Medicaid
LA2107399Medicaid
LA2107399Medicaid