Individual
KEITH J. FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1000 W 10TH ST, ROLLA, MO 65401-2905
(573) 364-9000
(573) 202-2484
Mailing address
1050 W 10TH ST, ROLLA, MO 65401-2905
(573) 364-9000
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
R4D88
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
242256303
—
MO
Enumeration date
08/30/2006
Last updated
12/27/2024
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