Individual
DR. FREDERICK RYAN LOCSO CABALLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
720 GOVERNOR MORRISON ST, SUITE 217, CHARLOTTE, NC 28211-3879
(704) 243-8346
Mailing address
40 VALLEY RD, JACKSON, NJ 08527-1824
(732) 367-8388
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2010-01344
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5918645
—
NC
05
—
NC1480
—
SC
Enumeration date
08/14/2007
Last updated
01/13/2012
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