Provider Demographics
NPI:1891013637
Name:LOBRANO, CHARLES MARION III (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MARION
Last Name:LOBRANO
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHASE
Other - Middle Name:
Other - Last Name:LOBRANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1534 ELIZABETH AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4531
Mailing Address - Country:US
Mailing Address - Phone:318-629-5001
Mailing Address - Fax:318-629-5020
Practice Address - Street 1:1500 LINE AVE STE 100
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4644
Practice Address - Country:US
Practice Address - Phone:318-635-3052
Practice Address - Fax:318-635-3072
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA301792207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program