Provider Demographics
NPI:1871597633
Name:VOCKE, GERALD W (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:W
Last Name:VOCKE
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 1:3645 HOUMA BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4229
Mailing Address - Country:US
Mailing Address - Phone:504-885-4677
Mailing Address - Fax:504-888-0549
Practice Address - Street 1:3645 HOUMA BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4229
Practice Address - Country:US
Practice Address - Phone:504-885-4677
Practice Address - Fax:504-888-0549
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA013737174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1173215Medicaid
LA5J827Medicare PIN
LAB60622Medicare UPIN
LA5J827C242Medicare PIN