Individual
JEFFREY L FREDERICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
120 PERSHING WAY, PADUCAH, KY 42001-8914
(270) 816-7526
(270) 908-8322
Mailing address
3805 STILL MEADOW LN, LEXINGTON, KY 40509-2951
(270) 816-7526
(270) 908-8322
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
43994
KY
207Q00000X
Family Medicine Physician
Primary
43994-A
KY
207QA0401X
Addiction Medicine (Family Medicine) Physician
43994
KY
208D00000X
General Practice Physician
43994
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
43994
KENTUCKY MEDICAL LICENSE
KY
05
—
7100109070
—
KY
Enumeration date
07/15/2006
Last updated
12/15/2025
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