Individual
DR. TIFFANY ANN FREDERICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8412 KITT PEAK RD, RAPID CITY, SD 57702-9512
(515) 201-8982
Mailing address
8412 KITT PEAK RD, RAPID CITY, SD 57702-9512
(515) 201-8982
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
9138
SD
208600000X
Surgery Physician
R-8763
IA
208600000X
Surgery Physician
TD151001
ME
Other
Enumeration date
06/19/2009
Last updated
09/15/2015
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