Provider Demographics
NPI:1689649394
Name:FRENCH, FREDERICK B (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:B
Last Name:FRENCH
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 1:303 W COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5892
Mailing Address - Country:US
Mailing Address - Phone:505-623-1442
Mailing Address - Fax:505-623-3835
Practice Address - Street 1:303 W COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5892
Practice Address - Country:US
Practice Address - Phone:505-623-1442
Practice Address - Fax:505-623-3835
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM80-148174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM16964Medicaid
D35639Medicare UPIN