Healthcare Provider Details

I. General information

NPI: 1558535740
Provider Name (Legal Business Name): FREDERICK BARRY AXELROD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 W ORANGE SHOW RD BLOOD BANK OF SAN BERNARDINO AND RIVERSIDE COUNTIES
SAN BERNARDINO CA
92408-2028
US

IV. Provider business mailing address

384 W ORANGE SHOW RD BLOOD BANK OF SAN BERNARDINO AND RIVERSIDE COUNTIES
SAN BERNARDINO CA
92408-2028
US

V. Phone/Fax

Practice location:
  • Phone: 909-885-6503
  • Fax: 909-381-2036
Mailing address:
  • Phone: 909-885-6503
  • Fax: 909-381-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberG60047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: