Healthcare Provider Details

I. General information

NPI: 1285751362
Provider Name (Legal Business Name): ANTHONY J. PALAZZO, M.D.,APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 AVENUE F
BOGALUSA LA
70427-3633
US

IV. Provider business mailing address

PO BOX 370
BOGALUSA LA
70429-0370
US

V. Phone/Fax

Practice location:
  • Phone: 985-732-1568
  • Fax: 985-732-4458
Mailing address:
  • Phone: 985-732-1568
  • Fax: 985-732-4458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPO4688
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD.07154R
License Number StateLA

VIII. Authorized Official

Name: ANTHONY JUDE PALAZZO
Title or Position: OWNER
Credential: MD
Phone: 985-732-1568