Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | R4D51 | MO |
NPI | 1205809175 |
---|---|
Provider Name | Dr. Carey S Fredman |
First Address | Saint Louis, MO 63195-2273 |
Second Address | Chesterfield, MO 63017-3610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
060061518 | RAILROAD MEDICARE IND # (01) | MO |
CH4229 | RR MEDICARE GROUP# (01) | MO |
E52607 | (02) | MO |