Provider Demographics
NPI:1669410171
Name:FAMBRO, JAMES EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:FAMBRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:985 ROBERT BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2063
Mailing Address - Country:US
Mailing Address - Phone:985-690-8300
Mailing Address - Fax:985-690-8301
Practice Address - Street 1:985 ROBERT BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2063
Practice Address - Country:US
Practice Address - Phone:985-690-8300
Practice Address - Fax:985-690-8301
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA13751R207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1434591Medicaid
LA4E931CN96Medicare ID - Type Unspecified
LAI3751RMedicare UPIN