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General NPI Number Information
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NPI Number | 1306917141
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Entity Type | Organization
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Legal Business Name | FREDERICKSBURG FAMILY CLINIC PA
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 11/18/2019
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Provider Practice Location Address
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Address Line | 514 W WINDCREST ST
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-4633
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Country | US
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Telephone | 830-997-0330
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Fax |
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Provider Business Mailing Address
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Address Line | 514 W WINDCREST ST
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-4633
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Country | US
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Telephone | 830-997-0330
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MS. JOHN FOSTER
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Credential |
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Telephone | 830-992-2720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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