Healthcare Provider Details

I. General information

NPI: 1891896437
Provider Name (Legal Business Name): JOHN ALEXANDER FRUTCHEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 OXFORD CT
SAFETY HARBOR FL
34695-5622
US

IV. Provider business mailing address

2307 OXFORD CT
SAFETY HARBOR FL
34695-5622
US

V. Phone/Fax

Practice location:
  • Phone: 727-725-3865
  • Fax:
Mailing address:
  • Phone: 727-725-3865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME61534
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: