Provider Demographics
NPI:1598803561
Name:FREDERICK L CURTIS M D INC
Entity type:Organization
Organization Name:FREDERICK L CURTIS M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:626-536-5828
Mailing Address - Street 1:41 W MIRA MONTE AVE
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-1226
Mailing Address - Country:US
Mailing Address - Phone:626-536-5828
Mailing Address - Fax:
Practice Address - Street 1:39 CONGRESS ST STE 310
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3022
Practice Address - Country:US
Practice Address - Phone:626-314-3245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55566207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW21424OtherMEDICARE GROUP PTAN
G69990Medicare UPIN