Individual
DR. DALE CARLTON FAZIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
1914 E 70TH ST, SUITE D, SHREVEPORT, LA 71105-5312
(318) 797-3470
(318) 797-9956
Mailing address
1914 E 70TH ST, SUITE D, SHREVEPORT, LA 71105-5312
(318) 797-3470
(318) 797-9956
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
PD009
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1318451
—
LA
Enumeration date
07/11/2005
Last updated
07/08/2007
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