Provider Demographics
NPI:1467499582
Name:LINDBERG, FREDERICK STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:STEPHEN
Last Name:LINDBERG
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 1:612 E JANSS RD
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5113
Mailing Address - Country:US
Mailing Address - Phone:805-373-0725
Mailing Address - Fax:805-373-0574
Practice Address - Street 1:612 E JANSS RD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5113
Practice Address - Country:US
Practice Address - Phone:805-373-0725
Practice Address - Fax:805-373-0574
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52787207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG52787OtherSTATE LICENSE
CAG52787Medicare PIN
CAG52787OtherSTATE LICENSE