Provider Demographics
NPI:1851350151
Name:BOZZELLE, JOSEPH ROBERT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ROBERT
Last Name:BOZZELLE
Suffix:JR
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 53069
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505
Mailing Address - Country:US
Mailing Address - Phone:337-837-3615
Mailing Address - Fax:337-839-8097
Practice Address - Street 1:501 W. ST. MARY BLVD
Practice Address - Street 2:STE 110
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506
Practice Address - Country:US
Practice Address - Phone:337-233-8887
Practice Address - Fax:337-233-8887
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024894174400000X
LAMD.024894208100000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1420255Medicaid
LAH78125Medicare UPIN
LA4E874-CK93Medicare ID - Type Unspecified