Healthcare Provider Details

I. General information

NPI: 1396309795
Provider Name (Legal Business Name): JOSEPH PANKRATZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 COOLIDGE BLVD
LAFAYETTE LA
70503-2621
US

IV. Provider business mailing address

1214 COOLIDGE BLVD
LAFAYETTE LA
70503-2621
US

V. Phone/Fax

Practice location:
  • Phone: 337-289-7991
  • Fax:
Mailing address:
  • Phone: 337-289-7991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number354353
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: