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1548682842
FREDERIC W NORTHERN
SANTA FE, NM
NPI
1548682842
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363AM0700X Physician Assistant, Medical
(Licence: NM PA2013-0085)
Enumeration Date
2014-01-06
Last Update Date
2014-01-06
Business Address
-- FREDERIC W NORTHERN PA-C
707 PASEO DE PERALTA
SANTA FE, NM 87501-1922
Phone number: 505-989-8707
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Mailing Address
-- FREDERIC W NORTHERN PA-C
401 E SENECA AVE
MCALESTER, OK 74501-6427
Phone number: 918-916-6894
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