MEDICARE: DAVID FRUGE CRNA

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
1	163WC0200X	Critical Care Medicine Registered Nurse	35000	LA
2	367500000X	Certified Registered Nurse Anesthetist	AP02716	LA
3	367500000X	Certified Registered Nurse Anesthetist	RN035000	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699750703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID FRUGE CRNA

Provider Business Mailing Address
First Line	:	5020 BELLE CHASSE DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71112-4532
Country	:	US
Telephone Number	:	318-742-3454
Fax Number	:

Provider Business Practice Location Address
First Line	:	8001 YOUREE DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71115-2302
Country	:	US
Telephone Number	:	318-212-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2005
Last Update Date	:	03/15/2026

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Directions to “ DAVID FRUGE CRNA” Practice Location

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