Provider Demographics
NPI:1962407882
Name:FEDRIGO, ANTHONY JAMES (DPM)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JAMES
Last Name:FEDRIGO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1125 SIR FRANCIS DRAKE BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1418
Mailing Address - Country:US
Mailing Address - Phone:415-461-6555
Mailing Address - Fax:415-461-6556
Practice Address - Street 1:1125 SIR FRANCIS DRAKE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1418
Practice Address - Country:US
Practice Address - Phone:415-461-6555
Practice Address - Fax:415-461-6556
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4298213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6444330001Medicare NSC
CA000E42980Medicare ID - Type Unspecified
CAU75487Medicare UPIN