Individual
JONATHAN FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
398 ASHE BLVD, SHEFFIELD, AL 35660-1729
(256) 383-1499
Mailing address
398 ASHE BLVD, SHEFFIELD, AL 35660-1729
(256) 383-1499
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
AL5271
AL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
AL28212
AL
Other
Enumeration date
01/04/2007
Last updated
11/15/2011
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