Provider Demographics
NPI:1902860851
Name:WEDEL, FREDERICK PARTINGTON (DO)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:PARTINGTON
Last Name:WEDEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 E HILLTOP PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5826
Mailing Address - Country:US
Mailing Address - Phone:520-325-3978
Mailing Address - Fax:520-325-3985
Practice Address - Street 1:3978 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-1460
Practice Address - Country:US
Practice Address - Phone:520-325-3978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1636207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD47191Medicare UPIN