Individual
DR. BRUCE E FREDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
550 HARRISON ST, STE 130, SYRACUSE, NY 13202-3064
(315) 464-4472
(315) 464-5223
Mailing address
550 HARRISON ST, STE 130, SYRACUSE, NY 13202-3064
(315) 464-4472
(315) 464-5223
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
122366
NY
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
122366
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00522514
—
NY
01
—
122366
LICENSE
NY
Enumeration date
06/16/2005
Last updated
10/05/2007
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