Provider Demographics
NPI:1841280872
Name:FREDRIKSSON, WILLIAM H JR (MD PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:H
Last Name:FREDRIKSSON
Suffix:JR
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 947407
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-7407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:1921 WALDEMERE ST STE 310
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2941
Practice Address - Country:US
Practice Address - Phone:941-917-5400
Practice Address - Fax:941-917-5420
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8037208800000X
FLME154478208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDB5442OtherBC NAMPA
ID000010153908OtherBS NAMPA
IDP00288611OtherRR MEDICARE
ID000010153906OtherBS MERIDIAN
ID76706OtherBC MERIDIAN
ID805784300Medicaid
IDP00288611OtherRR MEDICARE
IDB5442OtherBC NAMPA