Individual
FRED W FENDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3025 W CHERRY LANE, MERIDIAN, ID 83642
(208) 302-6400
(208) 302-6455
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 302-6400
(208) 302-6455
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M4500
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002576400
—
ID
Enumeration date
06/06/2006
Last updated
11/10/2016
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