Provider Demographics
NPI:1659362275
Name:STRAND, FREDERICK TIMOTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:TIMOTHY
Last Name:STRAND
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:PO BOX 2130
Mailing Address - Street 2:
Mailing Address - City:PINETOP
Mailing Address - State:AZ
Mailing Address - Zip Code:85935-2130
Mailing Address - Country:US
Mailing Address - Phone:928-368-8118
Mailing Address - Fax:928-368-8121
Practice Address - Street 1:728 E WHITE MTN BLVD
Practice Address - Street 2:STE C
Practice Address - City:PINETOP
Practice Address - State:AZ
Practice Address - Zip Code:85935
Practice Address - Country:US
Practice Address - Phone:928-368-8118
Practice Address - Fax:928-368-8121
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12506207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ297425Medicaid
AZD00035322OtherRAILROAD MEDICARE
AZ297425Medicaid
AZ83434Medicare ID - Type Unspecified