Provider Demographics
NPI:1669554390
Name:FAUVRE, FREDERICK MAYER (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:MAYER
Last Name:FAUVRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 MARICOPA HIGHWAY
Mailing Address - Street 2:SUITE I
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-3154
Mailing Address - Country:US
Mailing Address - Phone:805-646-8138
Mailing Address - Fax:805-646-3150
Practice Address - Street 1:1320 MARICOPA HIGHWAY
Practice Address - Street 2:SUITE I
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-3154
Practice Address - Country:US
Practice Address - Phone:805-646-8138
Practice Address - Fax:805-646-3150
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG18788207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40426Medicare UPIN
A40426Medicare UPIN