Provider Demographics
NPI:1437100211
Name:CARR, FREDERICK J (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:J
Last Name:CARR
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 1:4401 W MEMORIAL ROAD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73137-1722
Mailing Address - Country:US
Mailing Address - Phone:405-751-4664
Mailing Address - Fax:405-751-3183
Practice Address - Street 1:4101 TORRANCE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503
Practice Address - Country:US
Practice Address - Phone:310-543-5814
Practice Address - Fax:405-751-3183
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37335207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G373350Medicaid
A91884Medicare UPIN
CAWG37335DMedicare ID - Type Unspecified