Provider Demographics
NPI:1366735623
Name:FREDERICK, PAUL ADAM (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ADAM
Last Name:FREDERICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:401 MERIDIAN ST N STE 200
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4719
Mailing Address - Country:US
Mailing Address - Phone:256-705-3937
Mailing Address - Fax:256-533-3213
Practice Address - Street 1:401 MERIDIAN ST N STE 200
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4719
Practice Address - Country:US
Practice Address - Phone:256-705-3937
Practice Address - Fax:256-533-3213
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYR2751207W00000X
ALMD.35139207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology