Provider Demographics
NPI:1245213230
Name:FREDRIC, RHETT KEYSER (MD)
Entity Type:Individual
Prefix:DR
First Name:RHETT
Middle Name:KEYSER
Last Name:FREDRIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RHETT
Other - Middle Name:K
Other - Last Name:FREDRIC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PA
Mailing Address - Street 1:909 9TH AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3903
Mailing Address - Country:US
Mailing Address - Phone:817-338-9291
Mailing Address - Fax:817-335-2817
Practice Address - Street 1:909 9TH AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3903
Practice Address - Country:US
Practice Address - Phone:817-338-9291
Practice Address - Fax:817-335-2817
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0011207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
110056584OtherMEDICARE RAILROAD
TX175908601Medicaid
TX8AJ539OtherBCBS
TX8CQ911OtherBCBS
TX175911001Medicaid
TX175911002Medicaid
TX175908601Medicaid
TX00663XMedicare PIN
TX8C8446Medicare PIN
TXTXB117577Medicare PIN