| Doctor Name: | DR. FREDERICK VINCENT COVILLO |
| NPI Number: | 1376721159 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | R9069 |
| Business Practice Address: | 3401 Faraon St Saint Joseph, MO - 645065101 |
| Business Phone Number: | 8163872158 |
| Business Fax Number: | 8162324250 |
| Mailing Address: | 3401 Faraon St, SAINT JOSEPH |
| State: | MO |
| Postal Code: | 645065101 |
| Phone Number: | 8163872158 |
| Fax Number: | 8162324250 |
| NPI Enumeration Date: | 02/04/2008 |
| NPI Last Update Date: | 02/04/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | R9069 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |