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1578546610

NPI Code Detail

MEDICARE: JOHN W FREDERICK MD

MEDICARE: JOHN W FREDERICK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	H0359	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	83013K	OTHER	TX	BCBS
3	98085	OTHER	TX	SCOTT & WHITE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	113019102	OTHER	TX	FIRSTCARE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578546610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN W FREDERICK MD

Provider Business Mailing Address
First Line	:	4515 SETON CENTER PKWY
Second Line	:	SUITE 215 - CREDENTIALING
City	:	AUSTIN
State	:	TX
Zip	:	78759-5290
Country	:	US
Telephone Number	:	512-231-5507
Fax Number	:	512-406-6216

Provider Business Practice Location Address
First Line	:	6835 AUSTIN CENTER BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-3166
Country	:	US
Telephone Number	:	512-346-6611
Fax Number	:	512-406-7315

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	02/02/2017

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Directions to “ JOHN W FREDERICK MD” Practice Location

Language	Start Address	Practice Location

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