Individual
WARD FREDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3502 FRANKLIN AVE, BISMARCK, ND 58503-0761
(701) 222-2480
(701) 222-4537
Mailing address
PO BOX 2036, BISMARCK, ND 58502-2036
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
5170
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17511
—
ND
01
—
616
BLUE SHIELD
ND
01
—
CO4118
RR MEDICARE
ND
Enumeration date
08/31/2006
Last updated
12/07/2007
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