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NPI Code Detail

MEDICARE: DR. TIMOTHY WILLIAM FRIEDERICHS M.D.

MEDICARE: DR. TIMOTHY WILLIAM FRIEDERICHS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianG39073CA

General Provider Information

NPI Number : 1942419106
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIMOTHY WILLIAM FRIEDERICHS M.D.
Provider Business Mailing Address
First Line : 17577 CROSS RD
Second Line :
City : SALINAS
State : CA
Zip : 93907-1501
Country : US
Telephone Number : 831-663-2675
Fax Number : 831-678-5907
Provider Business Practice Location Address
First Line : CORRECTIONAL TRAINING FACILITY
Second Line : HIGHWAY 101, 4 MILES NORTH OF SOLEDAD
City : SOLEDAD
State : CA
Zip : 93960-9529
Country : US
Telephone Number : 831-678-3951
Fax Number : 831-678-5907
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2007
Last Update Date : 07/08/2007

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