Provider Demographics
NPI:1750428918
Name:BEHREND, ALBERT JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:JAMES
Last Name:BEHREND
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 2005
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-0005
Mailing Address - Country:US
Mailing Address - Phone:619-462-5916
Mailing Address - Fax:619-334-1313
Practice Address - Street 1:450 STABLERIDGE ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-1245
Practice Address - Country:US
Practice Address - Phone:619-462-5916
Practice Address - Fax:619-334-1313
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC40277208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C402770Medicaid
0000OtherTRICARE
CA00C402770Medicaid
0000OtherTRICARE
CAC40277Medicare ID - Type Unspecified