Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 015140 | LA |
NPI | 1003926981 |
---|---|
Provider Name | John Douglas Frusha |
First Address | Baton Rouge, LA 70809-3675 |
Second Address | Baton Rouge, LA 70809-3675 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1338702 | (05) | LA |
B61723 | (02) |