Provider Demographics
NPI:1811996192
Name:LOUPE, JACK FRANCIS (MD)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:FRANCIS
Last Name:LOUPE
Suffix:
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 1:8595 PICARDY AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3674
Mailing Address - Country:US
Mailing Address - Phone:225-763-4822
Mailing Address - Fax:
Practice Address - Street 1:8595 PICARDY AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3670
Practice Address - Country:US
Practice Address - Phone:225-763-4822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008284174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1029335Medicaid
LA1029335Medicaid
LAB64437Medicare UPIN
LA0697380001Medicare NSC