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General NPI Number Information
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NPI Number | 1710253836
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Entity Type | Organization
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Legal Business Name | JOHN G. FASICK DPM LLC
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Dates
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Enumeration Date | 03/23/2012
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Last Update Date | 03/23/2012
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Provider Practice Location Address
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Address Line | 3901 HOUMA BLVD SUITE 108
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City | METAIRIE
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State | LA
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Zip | 70006-2930
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Country | US
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Telephone | 504-301-1749
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Fax | 504-301-9451
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Provider Business Mailing Address
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Address Line | 3901 HOUMA BLVD SUITE 108
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City | METAIRIE
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State | LA
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Zip | 70006-2930
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Country | US
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Telephone | 504-301-1749
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Fax | 504-301-9451
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JOHN G FASICK II
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Credential | DPM
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Telephone | 504-301-1749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | DPM.PD284R
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License Number State | LA
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