Provider Demographics
NPI:1326030016
Name:KINDER, FREDERICK JOHN JR (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:JOHN
Last Name:KINDER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3133
Mailing Address - Country:US
Mailing Address - Phone:318-688-8804
Mailing Address - Fax:318-688-5473
Practice Address - Street 1:2508 BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:SUITE 201
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3133
Practice Address - Country:US
Practice Address - Phone:318-688-8804
Practice Address - Fax:318-688-5473
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022654207V00000X
LA22654207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1494810Medicaid
LAF6740OtherBLUE CROSS
LA1494810Medicaid
LAG96661Medicare UPIN