Provider Demographics
NPI:1487934584
Name:BARRAZA, JOHN MICHAEL II (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:BARRAZA
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8230 SUMMA AVE
Mailing Address - Street 2:STE C
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3465
Mailing Address - Country:US
Mailing Address - Phone:225-757-0552
Mailing Address - Fax:225-763-9997
Practice Address - Street 1:5000 HENNESSY BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4375
Practice Address - Country:US
Practice Address - Phone:225-757-0552
Practice Address - Fax:225-763-9997
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3223042085R0202X
LAINTERN390200000X
PAMT210265390200000X
TN533922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ028867Medicaid
TNQ028867OtherTSC
KY7100478620Medicaid