Healthcare Provider Details

I. General information

NPI: 1942289673
Provider Name (Legal Business Name): FREDERICK STANLEY WREFORD III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 COLLEGE BLVD STE 110
OVERLAND PARK KS
66210
US

IV. Provider business mailing address

7301 COLLEGE BLVD STE 110
OVERLAND PARK KS
66210-1856
US

V. Phone/Fax

Practice location:
  • Phone: 913-341-6297
  • Fax: 913-341-6299
Mailing address:
  • Phone: 913-341-6297
  • Fax: 913-341-6299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number04-41791
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: