Healthcare Provider Details

I. General information

NPI: 1861062929
Provider Name (Legal Business Name): ROBERT FRICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

4567 W PINE BLVD APT 706
SAINT LOUIS MO
63108-2192
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-6623
  • Fax:
Mailing address:
  • Phone: 254-541-6012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number2021023155
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA194817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: