Healthcare Provider Details

I. General information

NPI: 1558463364
Provider Name (Legal Business Name): GERALD S FREDMAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 INDIAN SCHOOL RD. NE
ALBUQUERQUE NM
87106-2653
US

IV. Provider business mailing address

2741 INDIAN SCHOOL RD. NE
ALBUQUERQUE NM
87106-2653
US

V. Phone/Fax

Practice location:
  • Phone: 505-837-9696
  • Fax: 505-883-3275
Mailing address:
  • Phone: 505-837-9696
  • Fax: 505-883-3275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number76172
License Number StateNM

VIII. Authorized Official

Name: DR. GERALD S. FREDMAN
Title or Position: PSYCHIATRIST/PRESIDENT
Credential: M.D.
Phone: 505-837-9696