Individual
JEFFREY ALAN FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3650 W ROCK CREEK RD, 110A, NORMAN, OK 73072-2202
(405) 364-2666
(405) 364-9627
Mailing address
4200 W MEMORIAL RD, 606, OKLAHOMA CITY, OK 73120-9350
(405) 755-1930
(405) 755-2795
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA 936
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100189640 A
—
OK
Enumeration date
06/29/2006
Last updated
07/15/2013
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