Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 14077R | LA |
NPI | 1194741355 |
---|---|
Provider Name | Dr. Victor Vincent Pouw |
First Address | Slidell, LA 70458-8056 |
Second Address | Lacombe, LA 70445-6403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 26/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1100617 | (05) | LA |
F88844 | (02) | LA |