Healthcare Provider Details

I. General information

NPI: 1801973581
Provider Name (Legal Business Name): DANIEL ANTHONY FREDERICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4316 JAMES CASEY ST STE B
AUSTIN TX
78745-1157
US

IV. Provider business mailing address

PO BOX 208357
DALLAS TX
75320-8354
US

V. Phone/Fax

Practice location:
  • Phone: 855-876-7246
  • Fax: 855-277-5070
Mailing address:
  • Phone: 512-485-7200
  • Fax: 844-364-8678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberL6044
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberL6044
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberL6044
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: