MEDICARE: FRED TOW M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	ME58474	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194766956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRED TOW M.D.

Provider Business Mailing Address
First Line	:	5700 LAKE WORTH RD
Second Line	:	STE 204
City	:	GREENACRES
State	:	FL
Zip	:	33463-3213
Country	:	US
Telephone Number	:	904-515-6909
Fax Number	:	904-515-6909

Provider Business Practice Location Address
First Line	:	8921 RAVEN ROCK CT
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33473-4831
Country	:	US
Telephone Number	:	941-356-2266
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	08/08/2017

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