Provider Demographics
NPI:1841224565
Name:CARRADINE, JOHN REMBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:REMBERT
Last Name:CARRADINE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 HOUMA BLVD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4182
Mailing Address - Country:US
Mailing Address - Phone:504-888-2797
Mailing Address - Fax:504-888-2637
Practice Address - Street 1:3800 HOUMA BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4182
Practice Address - Country:US
Practice Address - Phone:504-888-2797
Practice Address - Fax:504-888-2637
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD0111213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CE61Medicare PIN
LAU89197Medicare UPIN