Healthcare Provider Details

I. General information

NPI: 1790027589
Provider Name (Legal Business Name): MR. WILLIAM THOMAS VARNADO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5131 ODONOVAN DR
BATON ROUGE LA
70808-4791
US

IV. Provider business mailing address

4950 ESSEN LANE
BATON ROUGE LA
70809
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-1311
  • Fax:
Mailing address:
  • Phone: 225-767-1311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD.207270
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number207270
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: