Healthcare Provider Details

I. General information

NPI: 1447214143
Provider Name (Legal Business Name): ANGELO PAUL MORREALE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 N ASHLEY RIDGE LOOP SUITE 200
SHREVEPORT LA
71106-7232
US

IV. Provider business mailing address

PO BOX 52313
SHREVEPORT LA
71135-2313
US

V. Phone/Fax

Practice location:
  • Phone: 318-797-3668
  • Fax: 318-797-7977
Mailing address:
  • Phone: 318-797-3668
  • Fax: 318-797-7977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPDO64R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDPMPDO64R
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberDPMPDO64R
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberDPMPDO64R
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberDPMPDO64R
License Number StateLA
# 6
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberDPMPDO64R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: