Healthcare Provider Details

I. General information

NPI: 1497757223
Provider Name (Legal Business Name): JAMES R FREDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 KELE ST STE 401
KAHULUI HI
96732-3406
US

IV. Provider business mailing address

430 KELE ST STE 401
KAHULUI HI
96732-3406
US

V. Phone/Fax

Practice location:
  • Phone: 808-250-4427
  • Fax: 808-873-6429
Mailing address:
  • Phone: 808-250-4427
  • Fax: 808-873-6429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number13879
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: