Provider Demographics
NPI:1154862480
Name:FRUGE, JOHN DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DANIEL
Last Name:FRUGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 KALISTE SALOOM RD STE 202
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5784
Mailing Address - Country:US
Mailing Address - Phone:337-269-6335
Mailing Address - Fax:337-235-2765
Practice Address - Street 1:1103 KALISTE SALOOM RD STE 202
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5784
Practice Address - Country:US
Practice Address - Phone:337-269-6335
Practice Address - Fax:337-235-2765
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2023-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA326114208100000X, 2081P2900X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program