Provider Demographics
NPI:1588621247
Name:FREDERICK, FRANK L (DO)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:L
Last Name:FREDERICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:FRANK
Other - Middle Name:LO
Other - Last Name:FREDERICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:BOX 22063
Mailing Address - Street 2:DEPT 0289
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74121-2063
Mailing Address - Country:US
Mailing Address - Phone:405-751-4664
Mailing Address - Fax:405-751-4664
Practice Address - Street 1:2929 S GARNETT RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-5101
Practice Address - Country:US
Practice Address - Phone:918-665-1520
Practice Address - Fax:405-751-3183
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3661207P00000X
MO2008002409207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100255430DMedicaid
OKH31164Medicare UPIN
OK245515103Medicare PIN
OK100255430DMedicaid
OK930117536Medicare PIN
OK24H619007Medicare PIN
OKP00228291Medicare PIN