Individual
DR. MICHAEL WOODWORTH FREDRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1200 N BEAVER ST, FLAGSTAFF, AZ 86001-3118
(928) 779-3366
Mailing address
1200 N BEAVER ST, FLAGSTAFF, AZ 86001-3118
(928) 213-6235
(928) 213-6292
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
3679
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
597586
—
AZ
Enumeration date
08/05/2006
Last updated
09/09/2020
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