Provider Demographics
NPI:1508854258
Name:FIBER, FREDERICK (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:FIBER
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 1:401 EDITH BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2509
Mailing Address - Country:US
Mailing Address - Phone:505-243-8030
Mailing Address - Fax:505-842-1158
Practice Address - Street 1:401 EDITH BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2509
Practice Address - Country:US
Practice Address - Phone:505-243-8030
Practice Address - Fax:505-842-1158
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM79-103207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM201003032OtherPRESBYTERIAN HEALTH PLAN
NM22723Medicaid
NMNM011153OtherBCBS
NM22723Medicaid
$$$$$$$$$OtherPALMETTO GBA - RAILROAD MEDICARE
C97763Medicare UPIN