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Individual
TARA LEE FRERKS
Active
Individual
TARA LEE FRERKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
32903
SC
207Q00000X
Family Medicine Physician
Primary
52283
WI
207QS0010X
Sports Medicine (Family Medicine) Physician
32903
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32903
SC MEDICAL LICENSE, MEDICAL BOARD
SC
01
—
52283-020
WI LICENSE
WI
Enumeration date
11/11/2008
Last updated
03/13/2019
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