Knickerbocker, Fred R

Knickerbocker, Fred R is an individual health care provider with primary practice located at 260 Midway Medical Park Suite 100, Bristol TN 37620-1721. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as his primary health care specialty. Knickerbocker, Fred R can be contacted via phone (423) 968-4446.

Contact Information

Primary practice address
260 Midway Medical Park Suite 100 Bristol TN 37620-1721
Phone: (423) 968-4446
Fax: (423) 968-4802
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X 10490 Tennessee

Profile Details

NPI number 1588609242
LBN Legal business name Knickerbocker, Fred R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 18th, 2006
Last updated Mar 24th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1588609242 NPPES
Tennessee MEDICAID 3164215
Tennessee MEDICAID 006404766

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