Healthcare Provider Details

I. General information

NPI: 1063772424
Provider Name (Legal Business Name): CHAD ANTHONY DUFRENE ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2012
Last Update Date: 05/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1076 OAK HOLLOW DR
HAMMOND LA
70401-8258
US

IV. Provider business mailing address

1076 OAK HOLLOW DR
HAMMOND LA
70401-8258
US

V. Phone/Fax

Practice location:
  • Phone: 504-232-9589
  • Fax:
Mailing address:
  • Phone: 504-232-9589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATH.200196
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: