Provider Demographics
NPI:1053316570
Name:PIZARRO, ANTONIO R (MD)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:R
Last Name:PIZARRO
Suffix:
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 1:1801 FAIRFIELD AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4460
Mailing Address - Country:US
Mailing Address - Phone:318-221-0021
Mailing Address - Fax:318-221-0992
Practice Address - Street 1:1801 FAIRFIELD AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4443
Practice Address - Country:US
Practice Address - Phone:318-221-0021
Practice Address - Fax:318-221-0992
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA23827174400000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1487279Medicaid
LAH46233Medicare UPIN
LA4J189CQ79Medicare PIN