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NPI Code Detail

MEDICARE: MARIANNA RADIOLOGY

MEDICARE: MARIANNA RADIOLOGY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

General Provider Information

NPI Number : 1346202124
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARIANNA RADIOLOGY
Provider Business Mailing Address
First Line : PO BOX 357
Second Line :
City : JENNINGS
State : LA
Zip : 70546-0357
Country : US
Telephone Number : 337-824-4403
Fax Number : 337-824-9731
Provider Business Practice Location Address
First Line : 4250 HOSPITAL DR
Second Line :
City : MARIANNA
State : FL
Zip : 32446-1917
Country : US
Telephone Number : 850-526-2200
Fax Number : 850-718-2551
Authorized Official
Title or Position : OWNER/PARTNER
Name : RAUL OLAZABAL
Credential : M.D.
Telephone Number : 337-824-4403
Provider Enumeration Date : 04/05/2006
Last Update Date : 08/22/2020

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Directions to “MARIANNA RADIOLOGY ” Practice Location

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