Individual
THOMAS W FREDERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7500 MERCY RD, OMAHA, NE 68124-2319
(402) 343-4328
Mailing address
7500 MERCY RD, OMAHA, NE 68124-2319
(855) 524-4001
(402) 398-5589
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
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