Provider Demographics
NPI:1598769416
Name:STOCKTON, FREDERICK R (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:R
Last Name:STOCKTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SEAGATE STE 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:419-842-3000
Mailing Address - Fax:419-291-9883
Practice Address - Street 1:2940 N MCCORD RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1753
Practice Address - Country:US
Practice Address - Phone:419-842-3094
Practice Address - Fax:419-842-3048
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072291S207RC0000X, 207RI0011X
MI4301055113207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2032857Medicaid
P00711898OtherRRMC
OH0824328Medicare PIN
OH4010549Medicare PIN
OH060043870Medicare PIN
P00711898OtherRRMC
OH2032857Medicaid
OH4010546Medicare PIN
OH4134693Medicare PIN
OH0824326Medicare PIN
MI0N23450Medicare PIN
OH4010541Medicare PIN
OH4134695Medicare PIN
OH0824327Medicare PIN
OH4010544Medicare PIN
OH4134694Medicare PIN
OH0824325Medicare PIN
MI23450012Medicare PIN
OH4134691Medicare PIN
OH0824321Medicare PIN