Individual
DR. FREDERICK RANDALL KIRCHNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
471 ASHLEY RIDGE BLVD., SHREVEPORT, LA 71106
(318) 795-4770
(318) 795-4775
Mailing address
471 ASHLEY RIDGE BLVD., SHREVEPORT, LA 71106
(318) 795-4770
(318) 795-4775
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
010890
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
075555501
TEXAS MEDICAID NUMBER
TX
01
—
1053315846
GROUP NPI NUMBER
LA
05
—
1148300
—
LA
01
—
610748600
ARKANSAS MEDICAID NUMBER
AR
Enumeration date
07/18/2006
Last updated
01/12/2009
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