Provider Demographics
NPI:1053365775
Name:STERNBERG, FRED ARNOLD (DPM)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:ARNOLD
Last Name:STERNBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 VIRGINIA DR. SUITE A
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-3767
Mailing Address - Country:US
Mailing Address - Phone:972-264-3431
Mailing Address - Fax:972-642-4384
Practice Address - Street 1:2100 VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-3767
Practice Address - Country:US
Practice Address - Phone:972-264-3431
Practice Address - Fax:972-642-4384
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX0516213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT16113Medicare UPIN
TX00R774Medicare ID - Type Unspecified