Provider Demographics
NPI:1225031362
Name:BAYON, FRED (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:
Last Name:BAYON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 GLEN COVE MARINA RD E
Mailing Address - Street 2:STE 100
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-7284
Mailing Address - Country:US
Mailing Address - Phone:707-558-8699
Mailing Address - Fax:707-558-1864
Practice Address - Street 1:155 GLEN COVE MARINA RD E
Practice Address - Street 2:STE 100
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-7284
Practice Address - Country:US
Practice Address - Phone:707-558-8699
Practice Address - Fax:707-558-1864
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69611173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF02487Medicare UPIN
CA00G696110Medicare PIN