Individual
DR. FREDRIC LAX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
770 W HIGH ST, SUITE 390, LIMA, OH 45801-3990
(419) 996-5202
Mailing address
PO BOX 931843, CLEVELAND, OH 44193-0004
(937) 291-7850
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
35 067534
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000359907
ANTHEM BLUE CROSS
OH
05
—
0995062
—
OH
01
—
341105619-020
TRICARE SERVICES
SC
Enumeration date
05/01/2006
Last updated
03/30/2009
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