Individual
JOHN C FREDRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPO
Contact information
Practice address
9259 LAKE FISCHER BLVD, GOTHA, FL 34734-5204
(850) 247-8975
Mailing address
9259 LAKE FISCHER BLVD, GOTHA, FL 34734-5204
(850) 247-8975
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
POR13
FL
Other
Enumeration date
11/10/2020
Last updated
11/10/2020
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