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General NPI Number Information
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NPI Number | 1851515183
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Entity Type | Organization
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Legal Business Name | DRS. LOLLEY & ZIZZI AMC
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 11/01/2010
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Provider Practice Location Address
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Address Line | 102 THOMAS RD STE 203
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City | WEST MONROE
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State | LA
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Zip | 71291-5547
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Country | US
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Telephone | 318-387-1811
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Fax | 318-387-7529
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Provider Business Mailing Address
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Address Line | 102 THOMAS RD STE 203
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City | WEST MONROE
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State | LA
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Zip | 71291-5547
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Country | US
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Telephone | 318-387-1811
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Fax | 318-387-7529
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Authorized Official
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Title or Position | PRESIDENT
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Name | RUSSELL LOLLEY
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Credential | M.D.
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Telephone | 318-387-1811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 010612
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License Number State | LA
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