Provider Demographics
NPI:1437109329
Name:FROE, FELECIA (MD)
Entity Type:Individual
Prefix:
First Name:FELECIA
Middle Name:
Last Name:FROE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 HARRISON ST FL 7
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3466
Mailing Address - Country:US
Mailing Address - Phone:209-825-3700
Mailing Address - Fax:
Practice Address - Street 1:98-151 PALI MOMI ST
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4300
Practice Address - Country:US
Practice Address - Phone:808-483-6400
Practice Address - Fax:808-483-6488
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG88834208800000X
MOR7N95208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F57299Medicare UPIN