Individual
DR. FREDERICK W DANTAGNAN IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4228 HOUMA BLVD, STE 400, METAIRIE, LA 70006-3000
(504) 889-5250
(504) 889-5288
Mailing address
4228 HOUMA BLVD, STE 400, METAIRIE, LA 70006-3000
(504) 889-5250
(504) 889-5288
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
024747
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1575208
—
LA
01
—
4E268DH01
MEDICARE PTAN
LA
Enumeration date
02/08/2006
Last updated
08/07/2014
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