Basic Information
| Provider Information | |||||||||
| NPI: | 1831127513 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COCO | ||||||||
| FirstName: | JEFFERY | ||||||||
| MiddleName: | W. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3525 PRYTANIA ST | ||||||||
| Address2: | SUITE 526 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701153500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5046482520 | ||||||||
| FaxNumber: | 5048972064 | ||||||||
| Practice Location | |||||||||
| Address1: | 3525 PRYTANIA ST | ||||||||
| Address2: | SUITE 526 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701153500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5046482520 | ||||||||
| FaxNumber: | 5048972064 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 12/03/2009 | ||||||||
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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 | 207RI0200X | 018181 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | BC0241961 | 01 | FEDERAL DEA | OTHER | 1146081 | 05 | LA | MEDICAID |