MEDICARE: PATRICE R FREDERICK MD

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	208600000X	Surgery Physician	036117915	IL
2	208600000X	Surgery Physician	ME155086	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225288921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICE R FREDERICK MD

Provider Business Mailing Address
First Line	:	1290 WATERMAN WAY STE 1290
Second Line	:
City	:	TAVARES
State	:	FL
Zip	:	32778-5229
Country	:	US
Telephone Number	:	352-742-0054
Fax Number	:

Provider Business Practice Location Address
First Line	:	1290 WATERMAN WAY STE 1290
Second Line	:
City	:	TAVARES
State	:	FL
Zip	:	32778-5229
Country	:	US
Telephone Number	:	352-742-0054
Fax Number	:

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

Provider Enumeration Date	:	09/30/2008
Last Update Date	:	01/30/2023

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Directions to “ PATRICE R FREDERICK MD” Practice Location

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