1003897190 NPI number — DR. DANIEL FRANK FREDERICK

Table of content: DR. DANIEL FRANK FREDERICK (NPI 1003897190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003897190 NPI number — DR. DANIEL FRANK FREDERICK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREDERICK
Provider First Name:
DANIEL
Provider Middle Name:
FRANK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FREDERICK
Provider Other First Name:
DANIEL
Provider Other Middle Name:
FRANK
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1003897190
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1514 HATCHER LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38401-4825
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-381-7591
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1514 HATCHER LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38401-4825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-381-7591
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  #4059 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 65978 . This is a "MET LIFE" identifier . This identifiers is of the category "OTHER".
  • Identifier: CBTN1 . This is a "BCBS TENNESSEE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 52133 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 62308 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 80705 . This is a "GREAT WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: CDMIO . This is a "DELTA MICHIGAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60054 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 67814 . This is a "GE FINANCIAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 87726 . This is a "CIGNA (CRACKER BARREL)" identifier . This identifiers is of the category "OTHER".
  • Identifier: CDTN1 . This is a "DELTA TENNESSEE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10050 . This is a "CIGNA ( RUBY TUESDAY)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 47009 . This is a "AMERITUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 58066 . This is a "AFLAC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 61271 . This is a "PRINCIPAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 70408 . This is a "FORTIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 84056 . This is a "DELTA COLORADO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 94276 . This is a "DELTA GEORGIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: CDAR1 . This is a "DELTA ARKANSAS" identifier . This identifiers is of the category "OTHER".
  • Identifier: CDMN1 . This is a "DELTA MINNESOTA" identifier . This identifiers is of the category "OTHER".




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