Provider Demographics
NPI:1255313565
Name:DAVID, FREDERICK M (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:M
Last Name:DAVID
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 1:21680 ARDEN WAY
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007-8345
Mailing Address - Country:US
Mailing Address - Phone:530-365-2949
Mailing Address - Fax:530-365-2949
Practice Address - Street 1:376 VALLOMBROSA AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3900
Practice Address - Country:US
Practice Address - Phone:530-891-1676
Practice Address - Fax:530-891-1837
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28035207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43582Medicare UPIN