Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | MD.07154R | LA |
Y | 2080A0000X | Adolescent Medicine | MD.07154R | LA |
NPI | 1063457554 |
---|---|
Provider Name | Dr. Anthony Jude Palazzo |
First Address | Bogalusa, LA 70429-0370 |
Second Address | Bogalusa, LA 70427-3633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 21/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00018495 | (05) | MS |
1367061 | (05) | LA |
19669647423 | HUMANA (01) | LA |
4402936 | AETNA (01) | LA |
E24241 | (02) | LA |