Provider Demographics
NPI:1518987064
Name:ALTAZAN, JAMES D (PAC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:D
Last Name:ALTAZAN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 RUE DE LA VIE ST
Mailing Address - Street 2:SUITE 407
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-5127
Mailing Address - Country:US
Mailing Address - Phone:225-924-8298
Mailing Address - Fax:225-928-8856
Practice Address - Street 1:500 RUE DE LA VIE ST
Practice Address - Street 2:SUITE 407
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-5127
Practice Address - Country:US
Practice Address - Phone:225-924-8298
Practice Address - Fax:225-928-8856
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA10328363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5E839P282Medicare ID - Type Unspecified