Individual
MR. FREMONT FREDERICK ROESENER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2185 ORCHARD CT, TILLAMOOK, OR 97141-9432
(503) 842-4647
(503) 842-7617
Mailing address
PO BOX 417, TILLAMOOK, OR 97141-0417
(503) 842-8877
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD09045
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0011990001
REGENCE BLUE CROSS
OR
05
—
227231
—
OR
05
—
287791
—
OR
Enumeration date
08/24/2006
Last updated
07/09/2007
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