Provider Demographics
NPI:1821234857
Name:SMITH, FREDERICK REINDEL (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:REINDEL
Last Name:SMITH
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 2101
Mailing Address - Street 2:
Mailing Address - City:BORREGO SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92004
Mailing Address - Country:US
Mailing Address - Phone:760-767-0081
Mailing Address - Fax:760-767-0083
Practice Address - Street 1:3324 WAGON ROAD
Practice Address - Street 2:
Practice Address - City:BORREGO SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92004
Practice Address - Country:US
Practice Address - Phone:760-767-0081
Practice Address - Fax:760-767-0083
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAFE28277208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice