Provider Demographics
NPI:1912794793
Name:FREDERICKS, ROBERT ALLAN (HIS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLAN
Last Name:FREDERICKS
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 N 4TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5412
Mailing Address - Country:US
Mailing Address - Phone:903-601-3958
Mailing Address - Fax:903-601-0494
Practice Address - Street 1:713 N 4TH ST STE 1
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5412
Practice Address - Country:US
Practice Address - Phone:903-601-3958
Practice Address - Fax:903-306-0494
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81143237700000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist