Provider Demographics
NPI:1942256722
Name:MCCLENDON, FREDDIE D (MD)
Entity Type:Individual
Prefix:MR
First Name:FREDDIE
Middle Name:D
Last Name:MCCLENDON
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 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:4500 MORNING DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-7275
Practice Address - Country:US
Practice Address - Phone:661-437-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43654207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADH243VMedicare PIN
CAP01139791Medicare PIN
CA00G436541Medicare PIN
CADH243WMedicare PIN
CA050047990Medicare PIN
CADH243XMedicare PIN
CA00G436540Medicare PIN
CACD4582Medicare PIN
CAZZZ34009ZMedicare PIN