Provider Demographics
NPI:1861425324
Name:JOUDEH, JALAL (MD)
Entity type:Individual
Prefix:
First Name:JALAL
Middle Name:
Last Name:JOUDEH
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 1:601 W 4TH ST
Mailing Address - Street 2:P.O. BOX 866
Mailing Address - City:DEQUINCY
Mailing Address - State:LA
Mailing Address - Zip Code:70633-3301
Mailing Address - Country:US
Mailing Address - Phone:337-786-6161
Mailing Address - Fax:337-786-7999
Practice Address - Street 1:601 W 4TH ST
Practice Address - Street 2:
Practice Address - City:DEQUINCY
Practice Address - State:LA
Practice Address - Zip Code:70633-3301
Practice Address - Country:US
Practice Address - Phone:337-786-6161
Practice Address - Fax:337-786-7999
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11027R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1653811Medicaid
LA1653811Medicaid
LA5U978CF25Medicare PIN
LA5U978Medicare PIN