Healthcare Provider Details

I. General information

NPI: 1568455855
Provider Name (Legal Business Name): JOSEPH MARRAZZO III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/08/2007
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: 318-487-0595
Mailing address:
  • Phone: 318-487-8181
  • Fax: 318-487-0595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number15295
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: