MEDICARE: DR. WAYNE JOSEPH PHARO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	016262	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144267378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE JOSEPH PHARO M.D.

Provider Business Mailing Address
First Line	:	400 N ACADIA RD
Second Line	:
City	:	THIBODAUX
State	:	LA
Zip	:	70301-4856
Country	:	US
Telephone Number	:	985-448-0649
Fax Number	:	985-448-0785

Provider Business Practice Location Address
First Line	:	400 N ACADIA RD
Second Line	:
City	:	THIBODAUX
State	:	LA
Zip	:	70301-4856
Country	:	US
Telephone Number	:	985-448-0649
Fax Number	:	985-448-0785

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	04/06/2010

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