Provider Demographics
NPI:1255407110
Name:POCHE, JERRY M (MD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:M
Last Name:POCHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1645 LUTCHER AVE
Mailing Address - Street 2:
Mailing Address - City:LUTCHER
Mailing Address - State:LA
Mailing Address - Zip Code:70071-5150
Mailing Address - Country:US
Mailing Address - Phone:225-869-3493
Mailing Address - Fax:225-869-9333
Practice Address - Street 1:1645 LUTCHER AVE
Practice Address - Street 2:
Practice Address - City:LUTCHER
Practice Address - State:LA
Practice Address - Zip Code:70071-5150
Practice Address - Country:US
Practice Address - Phone:225-869-3493
Practice Address - Fax:225-869-9333
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA020655207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1398829Medicaid
LA5N993Medicare ID - Type Unspecified
LAF26487Medicare UPIN