Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP02104 | LA |
NPI | 1003254616 |
---|---|
Provider Name | Dr. Demetrius James Porche |
First Address | New Orleans, LA 70117-5737 |
Second Address | New Orleans, LA 70112-2262 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2013 |
Last Update Date | 06/06/2013 |