Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | FF3091573 | CO |
NPI | 1003010919 |
---|---|
Provider Name | Dr. Peter Daniel Fredericks |
First Address | Colorado Springs, CO 80910-3126 |
Second Address | Colorado Springs, CO 80910-3126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2007 |
Last Update Date | 06/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
54988764 | (05) | CO |