Basic Information
| Provider Information | |||||||||
| NPI: | 1194741355 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POUW | ||||||||
| FirstName: | VICTOR | ||||||||
| MiddleName: | VINCENT | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1430 LINDBERG DR | ||||||||
| Address2: | |||||||||
| City: | SLIDELL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704588056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9857817337 | ||||||||
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| Practice Location | |||||||||
| Address1: | 27350 HIGHWAY 190 | ||||||||
| Address2: | |||||||||
| City: | LACOMBE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704456403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858827077 | ||||||||
| FaxNumber: | 9858827079 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 05/26/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0205X | 14077R | LA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
ID Information
| ID | Type | State | Issuer | Description | 1100617 | 05 | LA | MEDICAID |