Healthcare Provider Details

I. General information

NPI: 1396063244
Provider Name (Legal Business Name): JOSEPH MARRAZZO, III, MD, APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2010
Last Update Date: 05/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MEDICAL CENTER DR SUITE 410
ALEXANDRIA LA
71301-8124
US

IV. Provider business mailing address

211 4TH ST BOX 30160
ALEXANDRIA LA
71301-8421
US

V. Phone/Fax

Practice location:
  • Phone: 318-487-8181
  • Fax:
Mailing address:
  • Phone: 318-487-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number015295
License Number StateLA

VIII. Authorized Official

Name: JOSEPH MARRAZZO III
Title or Position: PRESIDENT
Credential: M.D.
Phone: 318-487-8181