Provider Demographics
NPI:1346670106
Name:DAS, FREDERICK (CRNA)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:
Last Name:DAS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 W 109TH ST S
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-2686
Mailing Address - Country:US
Mailing Address - Phone:918-209-5532
Mailing Address - Fax:
Practice Address - Street 1:2020 W 109TH ST S
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-2686
Practice Address - Country:US
Practice Address - Phone:918-209-5532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0089495367500000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered