Individual
DR. FREDERICK ERWIN HACKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8535 MYRTLELAKE DR, BATON ROUGE, LA 70810-6631
(225) 810-6320
Mailing address
8535 MYRTLELAKE DR, BATON ROUGE, LA 70810-6631
(225) 810-6320
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD.05798R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04807394
—
MS
01
—
05798R
STATE LICENSE
LA
05
—
1321460
—
LA
Enumeration date
01/31/2007
Last updated
05/31/2013
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