DR. TIM E. FREDERICK MD NPI 1295803047

NPI Information

NPI: 1295803047
Provider Name: DR. TIM E. FREDERICK, MD
Classification: Psychiatry & Neurology - 2084N0400X
Entity Type: Individual

Specialization: Neurology

Address:
1965 S FREMONT AVE
SUITE 230
SPRINGFIELD, MO
ZIP 65804
Phone: (417) 820-9123
Get Directions

DR. Tim E. Frederick, MD is a neurology psychiatry neurology in Springfield, MO. The provider is a Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. DR. Tim E. Frederick, MD NPI is 1295803047. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1965 S FREMONT AVE
SUITE 230
SPRINGFIELD, MO
ZIP 65804-201
Phone: (417) 820-9123
Fax: (417) 820-3935

The enumeration date for this NPI number is 12/1/2006 and was last updated on 2/11/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2084N0400X	Psychiatry & Neurology	Neurology	2004004160	MISSOURI	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	919183268	MEDICARE PIN	MISSOURI
2	P00141755	OTHER		RAILROAD MEDICARE
3	431560263024	OTHER		TRICARE
4	B61956	MEDICARE UPIN	MISSOURI
5	208757807	MEDICAID	MISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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