Provider Demographics
NPI:1063457554
Name:PALAZZO, ANTHONY JUDE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JUDE
Last Name:PALAZZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.07154R207QA0401X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1367061Medicaid
MS00018495Medicaid
LA4402936OtherAETNA
LA19669647423OtherHUMANA
LA1367061Medicaid
LAE24241Medicare UPIN