Basic Information
| Provider Information | |||||||||
| NPI: | 1194728543 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SACCARO | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1211 COOLIDGE BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705032638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372898400 | ||||||||
| FaxNumber: | 3372898401 | ||||||||
| Practice Location | |||||||||
| Address1: | 1211 COOLIDGE BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705032638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372898400 | ||||||||
| FaxNumber: | 3372898401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2005 | ||||||||
| LastUpdateDate: | 11/15/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD024855 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 024855 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | 024855 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | MD024855 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1578771 | 05 | LA | MEDICAID |