Basic Information
| Provider Information | |||||||||
| NPI: | 1104189026 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FREDERICK | ||||||||
| FirstName: | DAVID | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7000 N MO PAC EXPY STE 420 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787313055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124820045 | ||||||||
| FaxNumber: | 5124769892 | ||||||||
| Practice Location | |||||||||
| Address1: | 919 E 32ND ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787052703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124472211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2012 | ||||||||
| LastUpdateDate: | 01/29/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5101019942 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 074006 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | R1963 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.