Individual
MARK R. FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1445 CHRISTY DR, JEFFERSON CITY, MO 65101-2853
(573) 636-3483
(573) 636-5315
Mailing address
1445 CHRISTY DR, JEFFERSON CITY, MO 65101-2853
(573) 636-3483
(573) 636-5315
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
R8B46
MO
Other
Enumeration date
09/20/2005
Last updated
10/15/2007
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