Provider Demographics
NPI:1558460261
Name:DEFRANCESCH, FRED (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:DEFRANCESCH
Suffix:
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 1:3001 19TH ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-4906
Mailing Address - Country:US
Mailing Address - Phone:504-469-9641
Mailing Address - Fax:985-479-8002
Practice Address - Street 1:2840 W AIRLINE HWY
Practice Address - Street 2:SUITE A
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-2951
Practice Address - Country:US
Practice Address - Phone:985-479-8000
Practice Address - Fax:985-479-8002
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0225962081P0004X, 208VP0014X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1490865Medicaid
LA1490865Medicaid
LA5A122Medicare ID - Type Unspecified