Individual
DR. GARY A. FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
905 S MAIN ST, SHATTUCK, OK 73858-9205
(580) 938-2551
(580) 938-2118
Mailing address
905 S MAIN ST, SHATTUCK, OK 73858-9205
(580) 938-2551
(580) 938-2118
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15799
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100652050B
—
OK
Enumeration date
07/12/2005
Last updated
10/21/2009
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