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General NPI Number Information
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NPI Number | 1346397239
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Entity Type | Individual
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Provider Name | JONATHAN FREDERICK MD
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Gender | Male
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 11/15/2011
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Provider Practice Location Address
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Address Line | 398 ASHE BLVD
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City | SHEFFIELD
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State | AL
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Zip | 35660-1729
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Country | US
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Telephone | 256-383-1499
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Fax |
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Provider Business Mailing Address
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Address Line | 398 ASHE BLVD
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City | SHEFFIELD
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State | AL
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Zip | 35660-1729
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Country | US
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Telephone | 256-383-1499
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | AL28212
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | AL5271
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License Number State | AL
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