Healthcare Provider Details

I. General information

NPI: 1023268117
Provider Name (Legal Business Name): FREDERICK W BILLEDEAUX BC-HIS,ACA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 01/20/2020
Certification Date: 01/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 JOHNSTON ST STE D
LAFAYETTE LA
70503-4253
US

IV. Provider business mailing address

4414 JOHNSTON ST STE D
LAFAYETTE LA
70503-4253
US

V. Phone/Fax

Practice location:
  • Phone: 337-989-4327
  • Fax: 337-989-4609
Mailing address:
  • Phone: 337-989-4327
  • Fax: 337-984-7914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number80185
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA0630
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1078
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: