Individual
MARK FREDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4502 MEDICAL DR, SAN ANTONIO, TX 78229-4402
(210) 257-1400
Mailing address
UTHSCSA, UTHSCSA, DEPT. OF REHAB MEDICINE, 7703 FLOYD CURL DRIVE, RM 628L, SAN ANTONIO, TX 78229
(210) 358-4451
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
K9535
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
043791501
—
TX
Enumeration date
08/24/2006
Last updated
07/08/2007
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