Provider Demographics
NPI:1356397186
Name:STODDARD, FRED RHODE (M D)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:RHODE
Last Name:STODDARD
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7250 AUBURN BLVD # 120
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-3850
Mailing Address - Country:US
Mailing Address - Phone:916-572-7755
Mailing Address - Fax:916-200-3215
Practice Address - Street 1:532 OREGON ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-3254
Practice Address - Country:US
Practice Address - Phone:707-649-4007
Practice Address - Fax:707-649-4077
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2024-07-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG35967174400000X
CA10-000016792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist