Individual
JOHN L FAMBROUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15781 PROFESSIONAL PLZ, HAMMOND, LA 70403-1452
(985) 542-1533
(985) 542-6713
Mailing address
15781 PROFESSIONAL PLZ, HAMMOND, LA 70403-1452
(985) 542-1533
(985) 542-6713
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
011330
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1172561
—
LA
01
—
51992C490
MEDICARE PTAN
LA
Enumeration date
06/14/2006
Last updated
02/24/2010
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