Provider Demographics
NPI:1659754919
Name:LABORDE, FREDERICK NELSON (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:NELSON
Last Name:LABORDE
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 1:14240 JOCKEY CIR S
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-1062
Mailing Address - Country:US
Mailing Address - Phone:516-589-9386
Mailing Address - Fax:
Practice Address - Street 1:3333 W COMMERCIAL BLVD STE 110
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3407
Practice Address - Country:US
Practice Address - Phone:954-530-9770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME134721207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty