Healthcare Provider Details

I. General information

NPI: 1629025168
Provider Name (Legal Business Name): CORI M FRERICHS P.A.-C.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: CORI M GEHMAN P.A.-C.

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 AIRPORT BLVD SUITE D-330
MOBILE AL
36608-6705
US

IV. Provider business mailing address

6701 AIRPORT BLVD SUITE D-330
MOBILE AL
36608-6705
US

V. Phone/Fax

Practice location:
  • Phone: 251-607-9797
  • Fax: 251-607-9761
Mailing address:
  • Phone: 251-607-9797
  • Fax: 251-607-9761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-394
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: