Provider Demographics
NPI:1851665707
Name:BILLIZON, FREDERICK WAYNE
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:WAYNE
Last Name:BILLIZON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 W TUNNEL BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2862
Mailing Address - Country:US
Mailing Address - Phone:985-876-8630
Mailing Address - Fax:
Practice Address - Street 1:1340 W TUNNEL BLVD STE 330
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2862
Practice Address - Country:US
Practice Address - Phone:985-876-8630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator