Provider Demographics
NPI:1780775890
Name:JOHN R. CARRADINE, D.P.M., L.L.C.
Entity type:Organization
Organization Name:JOHN R. CARRADINE, D.P.M., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:REMBERT
Authorized Official - Last Name:CARRADINE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:504-888-2797
Mailing Address - Street 1:3800 HOUMA BLVD
Mailing Address - Street 2:STE 260
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4184
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:STE 260
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4184
Practice Address - Country:US
Practice Address - Phone:504-888-2797
Practice Address - Fax:504-888-2637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD0111213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAU89197Medicare UPIN
LA4829180001Medicare NSC
LA5CE61Medicare ID - Type Unspecified