Provider Demographics
NPI:1518604958
Name:FRYOUX, JOHN LUKE (MSA, LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LUKE
Last Name:FRYOUX
Suffix:
Gender:M
Credentials:MSA, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10077 JUBAN CROSSING BLVD APT 604
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-8039
Mailing Address - Country:US
Mailing Address - Phone:225-335-2370
Mailing Address - Fax:
Practice Address - Street 1:12035 LA-431
Practice Address - Street 2:
Practice Address - City:ST. AMANT
Practice Address - State:LA
Practice Address - Zip Code:70774
Practice Address - Country:US
Practice Address - Phone:225-391-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA320899207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine