Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | A71441 | CA |
N | 207R00000X | Internist | A71441 | CA |
N | 111NI0900X | Internist | A71441 | CA |
Y | 207RG0100X | Gastroenterologist | A71441 | CA |
NPI | 1720009160 |
---|---|
Provider Name | Dr. Richard Todd Frederick |
First Address | Los Altos, CA 94022-1408 |
Second Address | San Francisco, CA 94109-6978 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 26/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A714410 | (05) | CA |
A71441 | STATE MEDICAL LICENSE (01) | CA |
I15756 | (02) | CA |