Provider Demographics
NPI:1427179845
Name:ANTONIO R. PIZARRO, MD, APMC
Entity Type:Organization
Organization Name:ANTONIO R. PIZARRO, MD, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:R
Authorized Official - Last Name:PIZARRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-221-0021
Mailing Address - Street 1:PO BOX 1466
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71164-1466
Mailing Address - Country:US
Mailing Address - Phone:318-221-0021
Mailing Address - Fax:318-221-0992
Practice Address - Street 1:1801 FAIRFIELD AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4443
Practice Address - Country:US
Practice Address - Phone:318-221-0021
Practice Address - Fax:318-221-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA23827207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1487279Medicaid
H46233Medicare UPIN
LA1487279Medicaid