Provider Demographics
NPI:1255825840
Name:DEROSIER, FREDERICK JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:JOSEPH
Last Name:DEROSIER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 TACKETTS POND DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7887
Mailing Address - Country:US
Mailing Address - Phone:919-475-1009
Mailing Address - Fax:
Practice Address - Street 1:1065 TACKETTS POND DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-7887
Practice Address - Country:US
Practice Address - Phone:919-475-1009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000282207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine