Healthcare Provider Details

I. General information

NPI: 1306057419
Provider Name (Legal Business Name): JENNIFER ROSE CHAPMAN-FREDRICKS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

969 NE 92ND ST
MIAMI SHORES FL
33138-2910
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6044
  • Fax:
Mailing address:
  • Phone: 954-415-2488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberME103429
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: