Healthcare Provider Details

I. General information

NPI: 1346202124
Provider Name (Legal Business Name): MARIANNA RADIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 HOSPITAL DR
MARIANNA FL
32446-1917
US

IV. Provider business mailing address

PO BOX 357
JENNINGS LA
70546-0357
US

V. Phone/Fax

Practice location:
  • Phone: 850-526-2200
  • Fax: 850-718-2551
Mailing address:
  • Phone: 337-824-4403
  • Fax: 337-824-9731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: RAUL OLAZABAL
Title or Position: OWNER/PARTNER
Credential: M.D.
Phone: 337-824-4403