Provider Demographics
NPI:1982617551
Name:ARSHAM, FREDERIC JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:JOEL
Last Name:ARSHAM
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 1:1834 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-2522
Mailing Address - Country:US
Mailing Address - Phone:760-789-2629
Mailing Address - Fax:760-788-3235
Practice Address - Street 1:1834 MAIN ST
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-2522
Practice Address - Country:US
Practice Address - Phone:760-789-2629
Practice Address - Fax:760-788-3235
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29610207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G296100Medicaid
CA00G296100Medicaid
CAA44086Medicare UPIN