Provider Demographics
NPI:1396063244
Name:JOSEPH MARRAZZO, III, MD, APMC
Entity type:Organization
Organization Name:JOSEPH MARRAZZO, III, MD, APMC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRAZZO
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:318-487-8181
Mailing Address - Street 1:211 4TH ST
Mailing Address - Street 2:BOX 30160
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-8421
Mailing Address - Country:US
Mailing Address - Phone:318-487-8181
Mailing Address - Fax:
Practice Address - Street 1:501 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 410
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8124
Practice Address - Country:US
Practice Address - Phone:318-487-8181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-16
Last Update Date:2010-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015295208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1995151Medicaid
5U622Medicare PIN
D21526Medicare UPIN