Individual
DR. FREDERICK JOE MCKIBBEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 W CALIFORNIA BLVD, PASADENA, CA 91105-3010
(626) 397-5000
(626) 397-2912
Mailing address
PO BOX 80278, CITY OF INDUSTRY, CA 91716-8278
(503) 372-2740
(503) 372-2554
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G55973
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G559730
BLUE SHIELD
CA
05
—
00G559730
—
CA
Enumeration date
07/26/2006
Last updated
11/22/2010
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