Provider Demographics
NPI:1902804214
Name:BRAZDA, FREDERICK WICKS (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:WICKS
Last Name:BRAZDA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1901 PERDIDO ST
Mailing Address - Street 2:PATHOLOGY DEPT. 5TH FLOOR
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-1393
Mailing Address - Country:US
Mailing Address - Phone:504-568-6031
Mailing Address - Fax:504-568-6037
Practice Address - Street 1:1901 PERDIDO ST
Practice Address - Street 2:PATHOLOGY DEPT. 5TH FLOOR
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-1393
Practice Address - Country:US
Practice Address - Phone:504-568-6031
Practice Address - Fax:504-568-6037
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2010-01-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA011447207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology