# DR. ROBERT W FREDERICK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1780658112
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | K7155 | TX | Yes |

## Other

- **Enumeration date:** 02/14/2006
- **Last updated:** 07/11/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 145418306 | — | TX |
| 05 | — | 145418307 | — | TX |
| 05 | — | 145418308 | — | TX |
| 01 | — | 75-2616977-007 | TRICARE-DOUGLAS | TX |
| 01 | — | 75-2616977-029 | TRICARE | TX |
| 01 | — | 75-2616977-126 | TRICARE | TX |
| 01 | — | 752616977029 | TRICARE ATHENS LOCATION | TX |