Individual
MARK ANTHONY PORTACCI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
706 ROSS STREET, OAK GROVE, LA 71263
(318) 428-3237
(318) 428-6180
Mailing address
706 ROSS STREET, OAK GROVE, LA 71263
(318) 428-3237
(318) 428-6180
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0015833
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1330957
—
LA
Enumeration date
12/04/2006
Last updated
02/11/2009
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