Individual
DR. BRIAN SHANE FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 E WOOD ST, SPARTANBURG, SC 29303-3040
(864) 560-7025
(864) 560-7388
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
R0699
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
238157
—
SC
05
—
5910691
—
NC
01
—
P00879458
RAILROAD MEDICARE
SC
Enumeration date
10/03/2006
Last updated
01/04/2021
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