Provider Demographics
NPI:1942465596
Name:FREDERICK L. KEPPEL M.D. P.M.C
Entity Type:Organization
Organization Name:FREDERICK L. KEPPEL M.D. P.M.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:KEPPEL M.D.
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-641-9855
Mailing Address - Street 1:1150 ROBERT BLVD
Mailing Address - Street 2:100
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2004
Mailing Address - Country:US
Mailing Address - Phone:985-641-9855
Mailing Address - Fax:
Practice Address - Street 1:1150 ROBERT BLVD
Practice Address - Street 2:100
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2004
Practice Address - Country:US
Practice Address - Phone:985-641-9855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016223174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1358517Medicaid
LAB62904Medicare UPIN
LA1358517Medicaid