Healthcare Provider Details

I. General information

NPI: 1477522365
Provider Name (Legal Business Name): DENNIS S FRERICHS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 N HOUK RD SUITE D
SPOKANE VALLEY WA
99216-1043
US

IV. Provider business mailing address

PO BOX 3649
SPOKANE WA
99220-3649
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-2531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA10005216
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: