Fazio, Dale Carlton

Fazio, Dale Carlton is an individual health care provider with primary practice located at 1914 E 70Th St Suite D, Shreveport LA 71105-5312. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Fazio, Dale Carlton can be contacted via phone (318) 797-3470.

Contact Information

Primary practice address
1914 E 70Th St Suite D Shreveport LA 71105-5312
Phone: (318) 797-3470
Fax: (318) 797-9956
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X PD009 Louisiana

Profile Details

NPI number 1194723577
LBN Legal business name Fazio, Dale Carlton
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 11th, 2005
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194723577 NPPES
Louisiana MEDICAID 1318451

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