Provider Demographics
NPI:1306826318
Name:FIELD, FREDERICK GEORGE (MD)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:GEORGE
Last Name:FIELD
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 1:1810 E 19TH ST STE 225
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3388
Mailing Address - Country:US
Mailing Address - Phone:541-296-6101
Mailing Address - Fax:541-296-3741
Practice Address - Street 1:1810 E 19TH ST STE 225
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3388
Practice Address - Country:US
Practice Address - Phone:541-296-6101
Practice Address - Fax:541-296-3741
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26105207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1122647Medicaid
OR005861Medicaid
OR133703Medicare PIN
OR005861Medicaid
WA1122647Medicaid