# JOHN G. FASICK DPM LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710253836
- **Authorized official:** DR. JOHN G FASICK II DPM (MANAGER)
- **Authorized official phone:** (504) 301-1749

## Contact information

- **Practice address:** 3901 HOUMA BLVD, SUITE 108, METAIRIE, LA 70006-2930
- **Practice address phone:** (504) 301-1749
- **Practice address fax:** (504) 301-9451
- **Mailing address:** 3901 HOUMA BLVD, SUITE 108, METAIRIE, LA 70006-2930
- **Mailing address phone:** (504) 301-1749
- **Mailing address fax:** (504) 301-9451

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | DPM.PD284R | LA | Yes |

## Other

- **Enumeration date:** 03/23/2012
- **Last updated:** 03/23/2012