Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | R3137 | AR |
NPI | 1003879362 |
---|---|
Provider Name | Dr. William R Frederick |
First Address | Helena, AR 72342 |
Second Address | Helena, AR 72342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D79432 | (02) |