Provider Demographics
NPI:1285751362
Name:ANTHONY J. PALAZZO, M.D.,APMC
Entity type:Organization
Organization Name:ANTHONY J. PALAZZO, M.D.,APMC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JUDE
Authorized Official - Last Name:PALAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-732-1568
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70429-0370
Mailing Address - Country:US
Mailing Address - Phone:985-732-1568
Mailing Address - Fax:985-732-4458
Practice Address - Street 1:405 AVENUE F
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3633
Practice Address - Country:US
Practice Address - Phone:985-732-1568
Practice Address - Fax:985-732-4458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.07154R174400000X
LAAPO4688363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1947717Medicaid