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General NPI Number Information
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NPI Number | 1558463364
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Entity Type | Organization
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Legal Business Name | GERALD S FREDMAN MD PC
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 04/24/2012
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Provider Practice Location Address
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Address Line | 2741 INDIAN SCHOOL RD. NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-2653
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Country | US
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Telephone | 505-837-9696
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Fax | 505-883-3275
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Provider Business Mailing Address
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Address Line | 2741 INDIAN SCHOOL RD. NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-2653
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Country | US
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Telephone | 505-837-9696
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Fax | 505-883-3275
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Authorized Official
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Title or Position | PSYCHIATRIST/PRESIDENT
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Name | DR. GERALD S. FREDMAN
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Credential | M.D.
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Telephone | 505-837-9696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 76172
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License Number State | NM
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