Provider Demographics
NPI:1275547242
Name:FRUGE, LLOYD MASON (MD)
Entity Type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:MASON
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 1:1011 S WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:TX
Mailing Address - Zip Code:75551-3245
Mailing Address - Country:US
Mailing Address - Phone:903-796-2868
Mailing Address - Fax:903-796-0826
Practice Address - Street 1:1011 SOUTH WILLIAM
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:TX
Practice Address - Zip Code:75551-3245
Practice Address - Country:US
Practice Address - Phone:903-796-2868
Practice Address - Fax:903-796-0826
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5067207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
010018015OtherMEDICARE RR
117625OtherCHIPS
TX124211703Medicaid
AR97278OtherBCBS
A0008OtherCHAMPUS
TX806057OtherBCBS
010018015OtherMEDICARE RR
AR97278OtherBCBS
TXC829Medicare ID - Type Unspecified