Provider Demographics
NPI:1114043320
Name:HASEMAN, FREDERICK (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:HASEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4889 CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-4951
Mailing Address - Country:US
Mailing Address - Phone:805-937-0465
Mailing Address - Fax:805-597-8354
Practice Address - Street 1:77 CASA ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-5803
Practice Address - Country:US
Practice Address - Phone:805-544-6471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28713174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG28173OtherSTATE ID
CA00G281730Medicaid
CAA43638Medicare UPIN
CAG28173AMedicare ID - Type Unspecified