Provider Demographics
NPI:1255666335
Name:BOLUDE, JOANN MODUPE (MD)
Entity type:Individual
Prefix:DR
First Name:JOANN
Middle Name:MODUPE
Last Name:BOLUDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:105 S. STEWART
Mailing Address - Street 2:
Mailing Address - City:COTULLA
Mailing Address - State:TX
Mailing Address - Zip Code:78014-1013
Mailing Address - Country:US
Mailing Address - Phone:830-879-3047
Mailing Address - Fax:210-277-6387
Practice Address - Street 1:OCHSNER HEALTHCARE
Practice Address - Street 2:1514 JEFFERSON HWY
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121
Practice Address - Country:US
Practice Address - Phone:504-703-0832
Practice Address - Fax:504-736-4623
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5763208D00000X, 207Q00000X
LA3485912080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX365574801Medicaid