Provider Demographics
NPI:1710901822
Name:NACHTWEY, FREDERICK JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:JOSEPH
Last Name:NACHTWEY
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 1:2637 SHADELANDS DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2512
Mailing Address - Country:US
Mailing Address - Phone:925-948-8143
Mailing Address - Fax:
Practice Address - Street 1:2101 VALE RD STE 300
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3846
Practice Address - Country:US
Practice Address - Phone:510-233-3788
Practice Address - Fax:510-233-3390
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35274207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0001530Medicaid
CAGR0001530Medicaid