Individual
MARC K FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2216 S FOOTHILL DR APT 310G, SALT LAKE CITY, UT 84109-3998
(517) 420-8771
Mailing address
2216 S FOOTHILL DR APT 310G, SALT LAKE CITY, UT 84109-3998
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
10/08/2018
Last updated
10/08/2018
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