Healthcare Provider Details

I. General information

NPI: 1790828911
Provider Name (Legal Business Name): JOHN THOMAS FREDERICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 02/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 5TH AVE STE 2010
SEATTLE WA
98101-3100
US

IV. Provider business mailing address

1200 5TH AVE STE 2010
SEATTLE WA
98101-3100
US

V. Phone/Fax

Practice location:
  • Phone: 206-778-5584
  • Fax:
Mailing address:
  • Phone: 206-778-5584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD00036632
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberMD00036632
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: