Individual
PATRICE R FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1290 WATERMAN WAY STE 1290, TAVARES, FL 32778-5229
(352) 742-0054
Mailing address
1290 WATERMAN WAY STE 1290, TAVARES, FL 32778-5229
(352) 742-0054
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036117915
IL
208600000X
Surgery Physician
Primary
ME155086
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036117915
—
IL
Enumeration date
09/30/2008
Last updated
01/30/2023
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