| Doctor Name: | DR. WILLIAM FREDERICK KORTUM |
| NPI Number: | 1225156151 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 027100 |
| Business Practice Address: | 3414 Moss St Ste A Lafayette, LA - 705076107 |
| Business Phone Number: | 3372351212 |
| Business Fax Number: | |
| Mailing Address: | 3414 Moss St Ste A, LAFAYETTE |
| State: | LA |
| Postal Code: | 705076107 |
| Phone Number: | 3372351212 |
| Fax Number: | |
| NPI Enumeration Date: | 03/27/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 027100 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |