Provider Demographics
NPI:1497757223
Name:FREDE, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:FREDE
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 1:430 KELE ST STE 401
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-3406
Mailing Address - Country:US
Mailing Address - Phone:808-250-4427
Mailing Address - Fax:808-873-6429
Practice Address - Street 1:430 KELE ST STE 401
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3406
Practice Address - Country:US
Practice Address - Phone:808-250-4427
Practice Address - Fax:808-873-6429
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI13879207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH330359461026OtherCARESOURCE
OH2139519Medicaid
OH000000177604OtherANTHEM
OH2188078OtherAETNA
OH0702306OtherUNITED HEALTH CARE
OH330359461026OtherCARESOURCE
OHA53204Medicare UPIN