Healthcare Provider Details

I. General information

NPI: 1003930280
Provider Name (Legal Business Name): DONNA BRIAN FARGASON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9311A BLUEBONNET BLVD
BATON ROUGE LA
70810-2806
US

IV. Provider business mailing address

9311A BLUEBONNET BLVD
BATON ROUGE LA
70810-2806
US

V. Phone/Fax

Practice location:
  • Phone: 225-769-5551
  • Fax: 225-769-5583
Mailing address:
  • Phone: 225-769-5551
  • Fax: 225-769-5583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number023078
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number023078
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: