Organization
OUR LADY OF LAKE ASCENSION, LLC
Active
Other names
St Elizabeth Physicians DSME Program
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN FREDERICK FRAICHE M.D. (PRESIDENT)
(225) 647-8511
Entity
Organization
Contact information
Practice address
2647 S SAINT ELIZABETH BLVD, GONZALES, LA 70737-5021
(225) 647-8511
Mailing address
2647 S SAINT ELIZABETH BLVD, GONZALES, LA 70737-5021
(225) 647-8511
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
—
—
Other
Enumeration date
10/05/2011
Last updated
10/05/2011
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