Individual
DR. FREDRICK BRUCE PACKARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
EDD
Contact information
Practice address
160 W FISH LN, SNOWFLAKE, AZ 85937-5085
(928) 225-9111
(928) 366-5988
Mailing address
160 W FISH LN, SNOWFLAKE, AZ 85937-5085
(928) 225-9111
(928) 774-1148
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3125
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3125
LICENSE NUMBER
AZ
Enumeration date
04/26/2006
Last updated
04/09/2021
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