Healthcare Provider Details

I. General information

NPI: 1982644027
Provider Name (Legal Business Name): NICHOLAS HUGH FRUGE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 E PRUDHOMME ST
OPELOUSAS LA
70570-6499
US

IV. Provider business mailing address

200 CORPORATE BLVD SUITE 201
LAFAYETTE LA
70508-3870
US

V. Phone/Fax

Practice location:
  • Phone: 337-981-8501
  • Fax:
Mailing address:
  • Phone: 800-893-9698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number020846
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: