Provider Demographics
NPI:1821099334
Name:FREDRIKSON, STEVEN E (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:E
Last Name:FREDRIKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1570 WOODRIDGE DR SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3818
Mailing Address - Country:US
Mailing Address - Phone:360-871-2223
Mailing Address - Fax:360-871-2227
Practice Address - Street 1:1570 WOODRIDGE DR SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3818
Practice Address - Country:US
Practice Address - Phone:360-871-2223
Practice Address - Fax:360-871-2227
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00017093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA06922Medicare UPIN