MEDICARE: DR. RHETT KEYSER FREDRIC 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	207RH0003X	Hematology & Oncology Physician	E0011	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110056584	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8AJ539	OTHER	TX	BCBS
4	8CQ911	OTHER	TX	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245213230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RHETT KEYSER FREDRIC MD

Provider Business Mailing Address
First Line	:	909 9TH AVE
Second Line	:	SUITE 402
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3903
Country	:	US
Telephone Number	:	817-338-9291
Fax Number	:	817-335-2817

Provider Business Practice Location Address
First Line	:	909 9TH AVE
Second Line	:	SUITE 402
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3903
Country	:	US
Telephone Number	:	817-338-9291
Fax Number	:	817-335-2817

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	03/24/2011

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Directions to “ DR. RHETT KEYSER FREDRIC MD” Practice Location

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