Individual
DR. TIM E. FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1965 S FREMONT AVE, SUITE 230, SPRINGFIELD, MO 65804-2201
(417) 820-9123
(417) 820-3935
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
2004004160
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208757807
—
MO
01
—
431560263024
TRICARE
—
01
—
P00141755
RAILROAD MEDICARE
—
Enumeration date
12/01/2006
Last updated
02/11/2011
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