Healthcare Provider Details

I. General information

NPI: 1609065812
Provider Name (Legal Business Name): PETER D VIZZI MD AMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 CAMELLIA BLVD 102
LAFAYETTE LA
70508-6766
US

IV. Provider business mailing address

1301 CAMELLIA BLVD 102
LAFAYETTE LA
70508-6766
US

V. Phone/Fax

Practice location:
  • Phone: 337-233-3201
  • Fax: 337-233-3207
Mailing address:
  • Phone: 337-233-3201
  • Fax: 337-233-3207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number15373R
License Number StateLA

VIII. Authorized Official

Name: DR. PETER D VIZZI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 337-233-3201