Provider Demographics
NPI:1558535740
Name:AXELROD, FREDERICK BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:BARRY
Last Name:AXELROD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 W ORANGE SHOW RD
Mailing Address - Street 2:BLOOD BANK OF SAN BERNARDINO AND RIVERSIDE COUNTIES
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-2028
Mailing Address - Country:US
Mailing Address - Phone:909-885-6503
Mailing Address - Fax:909-381-2036
Practice Address - Street 1:384 W ORANGE SHOW RD
Practice Address - Street 2:BLOOD BANK OF SAN BERNARDINO AND RIVERSIDE COUNTIES
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2028
Practice Address - Country:US
Practice Address - Phone:909-885-6503
Practice Address - Fax:909-381-2036
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60047207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine