Individual
BARRY L. FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, MPAS, RN, BSN
Contact information
Practice address
1150 ROBERT BLVD STE 240, SLIDELL, LA 70458-2005
(985) 646-3662
(985) 646-3691
Mailing address
1001 GAUSE BLVD # 75, SLIDELL, LA 70458-2939
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
A10586
LA
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
03/03/2006
Last updated
04/22/2020
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