MEDICARE: DR. BECKY JO FREDRICKSON M.D.,PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	L3649	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134129455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BECKY JO FREDRICKSON M.D.,PH.D.

Provider Business Mailing Address
First Line	:	2855 GRAMERCY ST STE 400
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-1697
Country	:	US
Telephone Number	:	713-668-6828
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 NORTH LOOP W STE 400
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1646
Country	:	US
Telephone Number	:	713-869-6400
Fax Number	:	713-869-6498

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	03/19/2021

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