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General NPI Number Information
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NPI Number | 1891013637
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Entity Type | Individual
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Provider Name | CHARLES MARION LOBRANO III MD
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Gender | Male
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Dates
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Enumeration Date | 05/04/2010
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1500 LINE AVE STE 100
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City | SHREVEPORT
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State | LA
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Zip | 71101-4644
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Country | US
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Telephone | 318-635-3052
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Fax | 318-635-3072
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Provider Business Mailing Address
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Address Line | 1534 ELIZABETH AVE STE 301
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City | SHREVEPORT
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State | LA
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Zip | 71101-4531
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Country | US
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Telephone | 318-629-5001
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Fax | 318-629-5020
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 301792
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License Number State | LA
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