Provider Demographics
NPI:1558463364
Name:GERALD S FREDMAN MD PC
Entity Type:Organization
Organization Name:GERALD S FREDMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:FREDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-837-9696
Mailing Address - Street 1:2741 INDIAN SCHOOL RD. NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2653
Mailing Address - Country:US
Mailing Address - Phone:505-837-9696
Mailing Address - Fax:505-883-3275
Practice Address - Street 1:2741 INDIAN SCHOOL RD. NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2653
Practice Address - Country:US
Practice Address - Phone:505-837-9696
Practice Address - Fax:505-883-3275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM761722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00NM00D979OtherBLUE CROSS BLUE SHIELD
NM00009589Medicaid
NM2270236Medicare ID - Type Unspecified
NM00NM00D979OtherBLUE CROSS BLUE SHIELD