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Individual

THOMAS W FREDERICKSON

Active
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Individual

THOMAS W FREDERICKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
04-26524
KS
207R00000X
Internal Medicine Physician
108755
MO
207R00000X
Internal Medicine Physician
Primary
26061
NE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100293960B
KS
05
100293960D
KS
01
110199606
RR MCR
MO
05
208471714
MO
01
2292243
AETNA
01
23432040
BCBS
01
738529
FIRST HEALTH
01
P00652380
RR MCR
KS
Enumeration date
08/24/2005
Last updated
09/29/2016
Update your record

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