Provider Demographics
NPI:1215135397
Name:ROBERT S FREDERICKS MD LTD
Entity type:Organization
Organization Name:ROBERT S FREDERICKS MD LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-348-1811
Mailing Address - Street 1:540 W PLUMB LN
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3666
Mailing Address - Country:US
Mailing Address - Phone:775-348-1811
Mailing Address - Fax:775-348-7139
Practice Address - Street 1:540 W PLUMB LN
Practice Address - Street 2:SUITE 2A
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3666
Practice Address - Country:US
Practice Address - Phone:775-348-1811
Practice Address - Fax:775-348-7139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VWCHGQMedicare PIN