Provider Demographics
NPI:1841207800
Name:HENDERSON, FREDERIC L (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:L
Last Name:HENDERSON
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 1:3500 N CAUSEWAY BLVD
Mailing Address - Street 2:STE 1410
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002
Mailing Address - Country:US
Mailing Address - Phone:504-838-9919
Mailing Address - Fax:504-834-3101
Practice Address - Street 1:3500 N CAUSEWAY BLVD
Practice Address - Street 2:STE 1410
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002
Practice Address - Country:US
Practice Address - Phone:504-838-9919
Practice Address - Fax:504-834-3101
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD03913R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1315346Medicaid
LA1315346Medicaid
LA5M293Medicare ID - Type Unspecified