Fred Black Md Pc

NPI 1710970330 - Family Medicine - 207Q00000X

NPI Details
NPI 1710970330
Enumeration Date 08/30/2005
Last Updated 11/21/2011
Entity Type Healthcare Provider
Active Over 11 years ago
Authorized Information
Name FREDERICK J FREDERICK
Position PRESIDENT
Phone (541) 672-0497
Fax (541) 957-2663
Practice Location
2282 NW TROOST ST
SUITE 103
ROSEBURG OR, 97471-6071, US
Phone (541) 672-0497
Fax (541) 957-2663
Business Location
2282 NW TROOST ST
SUITE 103
ROSEBURG OR, 97471-6071, US
Phone (541) 672-0497
Fax (541) 957-2663
Toxanomy
Taxonomy Code 207Q00000X
License State Oregon
License Number MD10476
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According to our database, Fred Black Md Pc NPI is 1710970330, taxonomy code is 207Q00000X and license number is MD10476, license state is located at Oregon. Fred Black Md Pc physically located at 2282 Nw Troost St, Roseburg OR, 97471-6071. NPI Number 1033115704 has the healthcare provider type.

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1710970330 NPI number is provided on an as is basis without warranty of any kind. 1710970330 is maintained by the National Plan & Provider Enumeration System. The contents of Fred Black Md Pc are for informational purposes only.