Provider Demographics
NPI:1932302056
Name:RHETT K FREDRIC, M.D. & ASSOCIATES
Entity Type:Organization
Organization Name:RHETT K FREDRIC, M.D. & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RHETT
Authorized Official - Middle Name:K
Authorized Official - Last Name:FREDRIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-338-9291
Mailing Address - Street 1:909 9TH AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3903
Mailing Address - Country:US
Mailing Address - Phone:817-338-9291
Mailing Address - Fax:817-335-2817
Practice Address - Street 1:909 9TH AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7400
Practice Address - Country:US
Practice Address - Phone:817-338-9291
Practice Address - Fax:817-335-2817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0011207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175908601Medicaid
TX0028QJOtherBCBS
TX0025WCOtherBCBS
DG4191OtherMEDICARE RAILROAD
TX0028QJOtherBCBS
TXTXB117576Medicare PIN