Provider Demographics
NPI:1609065812
Name:PETER D VIZZI MD AMC
Entity Type:Organization
Organization Name:PETER D VIZZI MD AMC
Other - Org Name:VIZZI, PETER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:VIZZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-233-3201
Mailing Address - Street 1:1301 CAMELLIA BLVD
Mailing Address - Street 2:102
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6766
Mailing Address - Country:US
Mailing Address - Phone:337-233-3201
Mailing Address - Fax:337-233-3207
Practice Address - Street 1:1301 CAMELLIA BLVD
Practice Address - Street 2:102
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6766
Practice Address - Country:US
Practice Address - Phone:337-233-3201
Practice Address - Fax:337-233-3207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15373R207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5196100001Medicare NSC
5CJ61Medicare PIN