Individual
HAL M FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2428 SANTA MONICA BLVD, SANTA MONICA, CA 90404-2045
(310) 315-1000
Mailing address
PO BOX 100041, KENNESAW, GA 30156-9241
(770) 779-2178
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
G52182
CA
2085R0202X
Diagnostic Radiology Physician
031741
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000393698
—
GA
Enumeration date
12/29/2005
Last updated
08/11/2022
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