Provider Demographics
NPI:1265521710
Name:SENDRA, FIDEL FABIAN (MD)
Entity type:Individual
Prefix:MR
First Name:FIDEL
Middle Name:FABIAN
Last Name:SENDRA
Suffix:
Gender:
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:PO BOX 321359
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-1359
Mailing Address - Country:US
Mailing Address - Phone:601-936-1395
Mailing Address - Fax:601-933-6596
Practice Address - Street 1:3311 PRESCOTT RD STE 312
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3984
Practice Address - Country:US
Practice Address - Phone:318-443-0490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13230R208G00000X
MS14594208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09826251Medicaid
LA1562769Medicaid
060060321OtherRR MEDICARE
5E954Medicare ID - Type Unspecified
LA1562769Medicaid