Healthcare Provider Details

I. General information

NPI: 1487934584
Provider Name (Legal Business Name): JOHN MICHAEL BARRAZA II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 HENNESSY BLVD
BATON ROUGE LA
70808-4375
US

IV. Provider business mailing address

8230 SUMMA AVE STE C
BATON ROUGE LA
70809-3465
US

V. Phone/Fax

Practice location:
  • Phone: 225-757-0552
  • Fax: 225-763-9997
Mailing address:
  • Phone: 225-757-0552
  • Fax: 225-763-9997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberINTERN
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT210265
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number322304
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number53392
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: