MEDICARE: STEVEN E FREDRIKSON 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	207Q00000X	Family Medicine Physician	MD00017093	WA

General Provider Information

NPI Number	:	1821099334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN E FREDRIKSON MD

Provider Business Mailing Address
First Line	:	1570 WOODRIDGE DR SE
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3818
Country	:	US
Telephone Number	:	360-871-2223
Fax Number	:	360-871-2227

Provider Business Practice Location Address
First Line	:	1570 WOODRIDGE DR SE
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3818
Country	:	US
Telephone Number	:	360-871-2223
Fax Number	:	360-871-2227

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	11/02/2007

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