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General NPI Number Information
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NPI Number | 1932083102
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Entity Type | Organization
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Legal Business Name | ANTHONY FREDERICKS MD LLC
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Dates
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Enumeration Date | 08/01/2025
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 4516 JOE DAN PL NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-5043
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Country | US
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Telephone | 760-707-8504
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Fax |
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Provider Business Mailing Address
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Address Line | 4516 JOE DAN PL NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-5043
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Country | US
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Telephone | 760-707-8504
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANTHONY FREDERICKS
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Credential | MD
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Telephone | 760-707-8504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Emergency Medicine) Physician
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License Number |
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License Number State |
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