MEDICARE: FREDERICK CHARLES DAVID 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
1	2085R0001X	Radiation Oncology Physician	G34598	CA
2	2085R0203X	Therapeutic Radiology Physician	G34598	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982793808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK CHARLES DAVID M.D.

Provider Business Mailing Address
First Line	:	3555 ROUND BARN CIRCLE
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1757
Country	:	US
Telephone Number	:	707-528-1050
Fax Number	:	707-576-0445

Provider Business Practice Location Address
First Line	:	3555 ROUND BARN CIRCLE
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1757
Country	:	US
Telephone Number	:	707-528-1050
Fax Number	:	707-576-0445

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	10/21/2021

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