Provider Demographics
NPI:1245259571
Name:KIRCHNER, FREDERICK RANDALL (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:RANDALL
Last Name:KIRCHNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 ASHLEY RIDGE BLVD.
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106
Mailing Address - Country:US
Mailing Address - Phone:318-795-4770
Mailing Address - Fax:318-795-4775
Practice Address - Street 1:471 ASHLEY RIDGE BLVD.
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106
Practice Address - Country:US
Practice Address - Phone:318-795-4770
Practice Address - Fax:318-795-4775
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010890207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX075555501OtherTEXAS MEDICAID NUMBER
LA1053315846OtherGROUP NPI NUMBER
LA1148300Medicaid
AR610748600OtherARKANSAS MEDICAID NUMBER
AR610748600OtherARKANSAS MEDICAID NUMBER
LA5K1776742Medicare PIN
LAB60763Medicare UPIN