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General NPI Number Information
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NPI Number | 1659551885
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Entity Type | Organization
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Legal Business Name | ROBERT L FRERICHS, MD PLLC
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 11/05/2007
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Provider Practice Location Address
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Address Line | 34612 6TH AVE S STE 100
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City | FEDERAL WAY
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State | WA
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Zip | 98003-8723
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Country | US
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Telephone | 253-237-0460
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Fax |
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Provider Business Mailing Address
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Address Line | 34612 6TH AVE S STE 100
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City | FEDERAL WAY
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State | WA
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Zip | 98003-8723
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Country | US
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Telephone | 253-237-0460
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Fax |
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | DR. ROBERT L FRERICHS
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Credential | MD
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Telephone | 253-588-7911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | MD00024815
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License Number State | WV
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