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General NPI Number Information
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NPI Number | 1649293515
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Entity Type | Individual
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Provider Name | FREDERICK STUART MITTLEMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 127 S 5TH AVE
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City | TUCSON
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State | AZ
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Zip | 85701-2005
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Country | US
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Telephone | 520-202-1888
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Fax | 520-202-1889
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Provider Business Mailing Address
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Address Line | 127 NORTH FIFTH AVE.
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City | TUCSON
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State | AZ
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Zip | 85701
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Country | US
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Telephone | 520-202-1758
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Fax | 520-882-0528
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 04-15284
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | R2C29
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 12229
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License Number State | NE
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 22730
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License Number State | CO
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D13793
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License Number State | MD
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Taxonomy #6
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101022130
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License Number State | VA
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Taxonomy #7
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036762
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License Number State | CT
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Taxonomy #8
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 36080
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License Number State | AZ
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