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1063407609
MARK R. FREDERICK
JEFFERSON CITY, MO
NPI
1063407609
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207L00000X Anesthesiology
(Licence: MO R8B46)
Enumeration Date
2005-09-20
Last Update Date
2007-10-15
Business Address
-- MARK R. FREDERICK DO
1445 CHRISTY DR
JEFFERSON CITY, MO 65101-2853
Phone number: 573-636-3483
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Mailing Address
-- MARK R. FREDERICK DO
1445 CHRISTY DR
JEFFERSON CITY, MO 65101-2853
Phone number: 573-636-3483
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