Individual
FREDDIE JOSEPH FANDAL JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17695 HWY 190, PORT BARRE, LA 70577
(337) 585-7898
(337) 585-7899
Mailing address
PO BOX 1338, PORT BARRE, LA 70577
(337) 585-7898
(337) 585-7899
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
024781
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080164292
RR MEDICARE
LA
05
—
1430692
—
LA
Enumeration date
03/21/2006
Last updated
12/08/2010
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