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NPI Code Detail

MEDICARE: MR. BRAD WILLIAM FRICK P.A.

MEDICARE: MR. BRAD WILLIAM FRICK P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantA10502RXLA

General Provider Information

NPI Number : 1639252992
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRAD WILLIAM FRICK P.A.
Provider Business Mailing Address
First Line : 121 E SAINT VICTOR ST
Second Line :
City : ABBEVILLE
State : LA
Zip : 70510-5120
Country : US
Telephone Number : 337-893-0810
Fax Number :
Provider Business Practice Location Address
First Line : 121 E SAINT VICTOR ST
Second Line :
City : ABBEVILLE
State : LA
Zip : 70510-5120
Country : US
Telephone Number : 337-893-0810
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2006
Last Update Date : 07/08/2007

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