Provider Demographics
NPI:1720099344
Name:OPERARIO, MARK ANTHONY HERRERA (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANTHONY HERRERA
Last Name:OPERARIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:370 HEARN ISLAND
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:LA
Mailing Address - Zip Code:71418
Mailing Address - Country:US
Mailing Address - Phone:318-649-3232
Mailing Address - Fax:318-649-5094
Practice Address - Street 1:412 MAIN STREET
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:LA
Practice Address - Zip Code:71418
Practice Address - Country:US
Practice Address - Phone:318-649-6111
Practice Address - Fax:318-649-5094
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD11362R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1661881Medicaid
LAG12013Medicare UPIN
LA1661881Medicaid