Individual
DR. ROBERT W FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
703 E MARSHALL AVE STE 5007, LONGVIEW, TX 75601
(903) 315-4455
(903) 315-2466
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
K7155
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145418306
—
TX
05
—
145418307
—
TX
05
—
145418308
—
TX
01
—
75-2616977-007
TRICARE-DOUGLAS
TX
01
—
75-2616977-029
TRICARE
TX
01
—
75-2616977-126
TRICARE
TX
01
—
752616977029
TRICARE ATHENS LOCATION
TX
Enumeration date
02/14/2006
Last updated
07/11/2018
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