Healthcare Provider Details

I. General information

NPI: 1275820797
Provider Name (Legal Business Name): MARCUS ALEXANDER BACHHUBER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CANAL ST
NEW ORLEANS LA
70112-3018
US

IV. Provider business mailing address

533 BOLIVAR ST FL 5
NEW ORLEANS LA
70112-1349
US

V. Phone/Fax

Practice location:
  • Phone: 504-962-6106
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number310567
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number310567
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: