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Individual

DR. LEROY E FREDERICKS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2770 3RD AVE STE 210, LAKE CHARLES, LA 70601-0404
(337) 494-6768
(337) 494-6792
Mailing address
PO BOX 122579, DEPT 2579, DALLAS, TX 75312-2579
(337) 494-2921
(337) 494-6523

Taxonomy

Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
MD10005R
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1491217
LA
01
MD.10005R
STATE MEDICAL LICENSE
LA
Enumeration date
03/20/2007
Last updated
04/27/2022
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