Individual
DR. FREDERICK A LODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
580 N SPRING ST, UKIAH, CA 95482-4251
(707) 468-5015
(707) 468-5015
Mailing address
PO BOX 492680, REDDING, CA 96049-2680
(530) 243-0440
(530) 243-0445
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
G57207
CA
207L00000X
Anesthesiology Physician
Primary
00G572072
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
YYY20507Y
—
CA
Enumeration date
09/19/2005
Last updated
07/30/2010
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