MEDICARE: DR. FRANK B FONDREN III 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	207X00000X	Orthopaedic Surgery Physician	10207	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	582683208	OTHER		HUMANA
2	515-21504	OTHER	AL	BCBS BAY MINETTE
3	51523099	OTHER	AL	BLUE CROSS BLUE SHIELD
4	900884	OTHER	AL	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1952382293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRANK B FONDREN III M.D.

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

Provider Business Practice Location Address
First Line	:	1903 HAND AVE
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-4112
Country	:	US
Telephone Number	:	251-580-1701
Fax Number	:	251-580-1702

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

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	01/19/2023

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