Healthcare Provider Details

I. General information

NPI: 1083751457
Provider Name (Legal Business Name): FREDERICK L. YERBY, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 TEMPLE AVE N SUITE 6
FAYETTE AL
35555-1309
US

IV. Provider business mailing address

1716 TEMPLE AVE N SUITE 6
FAYETTE AL
35555-1309
US

V. Phone/Fax

Practice location:
  • Phone: 205-932-7750
  • Fax: 205-932-6293
Mailing address:
  • Phone: 205-932-7750
  • Fax: 205-932-6293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15356
License Number StateAL

VIII. Authorized Official

Name: DR. FREDERICK LEE YERBY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 205-932-7750