Provider Demographics
NPI:1700864642
Name:UHRLE, FRED JOHNSON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:JOHNSON
Last Name:UHRLE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1193 E HERNDON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3156
Mailing Address - Country:US
Mailing Address - Phone:559-435-8381
Mailing Address - Fax:559-435-1225
Practice Address - Street 1:1193 E HERNDON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3156
Practice Address - Country:US
Practice Address - Phone:559-435-8381
Practice Address - Fax:559-435-1225
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40186174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29071Medicare UPIN
CA00A401860Medicare ID - Type Unspecified