Provider Demographics
NPI:1154741379
Name:HURST, FRITZ
Entity type:Individual
Prefix:
First Name:FRITZ
Middle Name:
Last Name:HURST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7810 BAJA DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70811-7735
Mailing Address - Country:US
Mailing Address - Phone:225-324-3136
Mailing Address - Fax:225-356-0381
Practice Address - Street 1:7810 BAJA DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70811-7735
Practice Address - Country:US
Practice Address - Phone:225-324-3136
Practice Address - Fax:225-356-0381
Is Sole Proprietor?:No
Enumeration Date:2014-04-27
Last Update Date:2014-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA880039171W00000X
LA49250171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor