Healthcare Provider Details

I. General information

NPI: 1487927992
Provider Name (Legal Business Name): FRANK DENNIS DUFOUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 AIROLE WAY
LOS ANGELES CA
90077-2601
US

IV. Provider business mailing address

919 AIROLE WAY
LOS ANGELES CA
90077-2601
US

V. Phone/Fax

Practice location:
  • Phone: 310-694-8530
  • Fax: 775-200-0625
Mailing address:
  • Phone: 310-694-8530
  • Fax: 775-200-0625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberAFE26051
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: