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Individual

JOHN THOMAS FREDERICK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1200 5TH AVE STE 2010, SEATTLE, WA 98101-3100
(206) 778-5584
Mailing address
1200 5TH AVE STE 2010, SEATTLE, WA 98101-3100
(206) 778-5584

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD00036632
WA
2084P0805X
Geriatric Psychiatry Physician
MD00036632
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0163635
VM LABOR AND INDUSTRIES #
WA
01
3015FR
VM BLUE SHIELD #
WA
05
8286858
WA
01
8883129
MEDICARE - SNO CO
WA
01
P00444827
VM RAILROAD MC #
WA
01
US7536792
VM AETNA PCP PIN
WA
Enumeration date
02/15/2007
Last updated
02/20/2018
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