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General NPI Number Information
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NPI Number | 1124915202
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Entity Type | Individual
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Provider Name | CHRISTIAN JOSEPH FREDERICKSON MD
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Gender | Male
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Dates
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Enumeration Date | 06/20/2025
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 1401 JEFFERSON HWY FL CENTER1
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City | JEFFERSON
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State | LA
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Zip | 70121-2426
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Country | US
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Telephone | 504-842-3260
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Fax | 504-842-3193
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Provider Business Mailing Address
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Address Line | 4206 S GALVEZ ST
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City | NEW ORLEANS
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State | LA
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Zip | 70125-4524
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Country | US
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Telephone | 301-222-7889
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 347615
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License Number State | LA
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