Provider Demographics
NPI:1225034812
Name:FRUGE, BERNARD C JR (MD)
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:C
Last Name:FRUGE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:320 SETTLERS TRACE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508
Mailing Address - Country:US
Mailing Address - Phone:337-981-9495
Mailing Address - Fax:337-981-7451
Practice Address - Street 1:320 SETTLERS TRACE BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-981-9495
Practice Address - Fax:337-981-7451
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA016613207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1349691Medicaid
MA5J947Medicare PIN
LA1349691Medicaid