Healthcare Provider Details

I. General information

NPI: 1184732299
Provider Name (Legal Business Name): MARSHALL DUVALL FITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 PERDIDO ST
NEW ORLEANS LA
70112-1262
US

IV. Provider business mailing address

424 SEGUIN ST
NEW ORLEANS LA
70114-2358
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-0811
  • Fax:
Mailing address:
  • Phone: 504-263-8343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number10879R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: