Organization
BRYAN G FRENTZ - A PROFESSIONAL MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACY FRENTZ (PRACTICE MANAGER)
(337) 254-9980
Entity
Organization
Contact information
Practice address
1151 MARGUERITE ST, SUITE 700 B, MORGAN CITY, LA 70380-1850
(985) 221-4320
Mailing address
203 PRINCETON WOODS LOOP, LAFAYETTE, LA 70508-6601
(337) 254-9980
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
MD.024773
LA
332900000X
Non-Pharmacy Dispensing Site
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7633960001
MEDICARE NSC
—
Enumeration date
05/05/2017
Last updated
03/12/2019
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