Provider Demographics
NPI:1710207923
Name:BRONSON, FREDRICK HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:FREDRICK
Middle Name:HOWARD
Last Name:BRONSON
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 1:13 CHEROKEE CIRCLE
Mailing Address - Street 2:102
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-8481
Mailing Address - Country:US
Mailing Address - Phone:608-467-6766
Mailing Address - Fax:
Practice Address - Street 1:13 CHEROKEE CIR
Practice Address - Street 2:102
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-8480
Practice Address - Country:US
Practice Address - Phone:608-467-6766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14964208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB4058536OtherDEA