Individual
WARD FREDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
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
Update your record
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