Healthcare Provider Details

I. General information

NPI: 1639661978
Provider Name (Legal Business Name): CHRISTOPHER FREDERICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2018
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 836 BOX 374
FPO AE
09636-0007
US

IV. Provider business mailing address

PSC 836 BOX 374
FPO AE
09636-0007
US

V. Phone/Fax

Practice location:
  • Phone: 671-344-9340
  • Fax:
Mailing address:
  • Phone: 671-344-9340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01082591A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: