Healthcare Provider Details

I. General information

NPI: 1124915202
Provider Name (Legal Business Name): CHRISTIAN JOSEPH FREDERICKSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 JEFFERSON HWY FL CENTER1
JEFFERSON LA
70121-2426
US

IV. Provider business mailing address

4206 S GALVEZ ST
NEW ORLEANS LA
70125-4524
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-3260
  • Fax: 504-842-3193
Mailing address:
  • Phone: 301-222-7889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number347615
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: