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General NPI Number Information
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NPI Number | 1912794793
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Entity Type | Individual
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Provider Name | ROBERT ALLAN FREDERICKS HIS
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Gender | Male
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Dates
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Enumeration Date | 04/23/2025
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 713 N 4TH ST STE 1
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City | LONGVIEW
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State | TX
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Zip | 75601-5412
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Country | US
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Telephone | 903-601-3958
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Fax | 903-306-0494
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Provider Business Mailing Address
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Address Line | 713 N 4TH ST STE 1
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City | LONGVIEW
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State | TX
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Zip | 75601-5412
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Country | US
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Telephone | 903-601-3958
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Fax | 903-601-0494
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 81143
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 81143
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License Number State | TX
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