Individual
FREDERICK WILLIAM PENCZAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
78 CREEKSIDE DR, SAN RAFAEL, CA 94903-1055
(707) 939-7411
(707) 939-1617
Mailing address
PO BOX 1964, SONOMA, CA 95476-1964
(707) 939-7411
(707) 939-1617
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
00A685120
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A685120
—
CA
Enumeration date
11/06/2006
Last updated
04/25/2014
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