Provider Demographics
NPI:1881798221
Name:RICHBURG, FREDERICK ALLEN II (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:ALLEN
Last Name:RICHBURG
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:6699 ALVARADO RD
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5238
Mailing Address - Country:US
Mailing Address - Phone:619-229-3909
Mailing Address - Fax:619-229-3902
Practice Address - Street 1:4010 SORRENTO VALLEY BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1432
Practice Address - Country:US
Practice Address - Phone:858-793-7860
Practice Address - Fax:858-436-1289
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2011-11-11
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Provider Licenses
StateLicense IDTaxonomies
CAA54679207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG84734Medicare UPIN