Provider Demographics
NPI:1205168234
Name:SHIPLEY, FREDRICK FRANCIS (LMT)
Entity type:Individual
Prefix:MR
First Name:FREDRICK
Middle Name:FRANCIS
Last Name:SHIPLEY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21550 NE KINGS GRADE
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-6519
Mailing Address - Country:US
Mailing Address - Phone:503-310-6765
Mailing Address - Fax:
Practice Address - Street 1:21550 NE KINGS GRADE
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-6519
Practice Address - Country:US
Practice Address - Phone:503-310-6765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8024171W00000X
WAMA 00016730174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No174400000XOther Service ProvidersSpecialist