Provider Demographics
NPI:1356455737
Name:FREMIN, ROSS JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:JOHN
Last Name:FREMIN
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 1:1115 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-6162
Mailing Address - Country:US
Mailing Address - Phone:337-364-5503
Mailing Address - Fax:337-364-5503
Practice Address - Street 1:1115 CENTER ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-6162
Practice Address - Country:US
Practice Address - Phone:337-364-5503
Practice Address - Fax:337-364-5503
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025620207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1055051Medicaid
LA4K290Medicare PIN
LAI63368Medicare UPIN