Provider Demographics
NPI:1740226802
Name:CHANDLER, RODERICK W JR (MD)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:W
Last Name:CHANDLER
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 1:2330 N CAUSEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-6402
Mailing Address - Country:US
Mailing Address - Phone:985-674-1700
Mailing Address - Fax:985-674-1722
Practice Address - Street 1:2330 N CAUSEWAY BLVD
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-6402
Practice Address - Country:US
Practice Address - Phone:985-674-1700
Practice Address - Fax:985-674-1722
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.025612207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1046230Medicaid
LA1046230Medicaid
4K100Medicare ID - Type Unspecified