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 1:6600 S YALE AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3361
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-6509
Practice Address - Country:US
Practice Address - Phone:918-245-2286
Practice Address - Fax:918-241-4366
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008002409207P00000X
OK3661207P00000X
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