1952382293 NPI number — DR. FRANK B FONDREN III M.D.

Table of content: DR. FRANK B FONDREN III M.D. (NPI 1952382293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952382293 NPI number — DR. FRANK B FONDREN III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FONDREN
Provider First Name:
FRANK
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952382293
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1147
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY MINETTE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36507-1147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-580-1701
Provider Business Mailing Address Fax Number:
251-580-1702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1903 HAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAY MINETTE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36507-4112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-580-1701
Provider Business Practice Location Address Fax Number:
251-580-1702
Provider Enumeration Date:
11/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  10207 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 582683208 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 515-21504 . This is a "BCBS BAY MINETTE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51523099 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 900884 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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