Healthcare Provider Details

I. General information

NPI: 1346358843
Provider Name (Legal Business Name): JOHN WAYNE FRICKER JR. DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 11/11/2023
Certification Date: 11/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 DIAGNOSTIC DR STE A
FRANKFORT KY
40601-6557
US

IV. Provider business mailing address

110 DIAGNOSTIC DR STE A
FRANKFORT KY
40601-6557
US

V. Phone/Fax

Practice location:
  • Phone: 502-219-7937
  • Fax: 502-219-7948
Mailing address:
  • Phone: 502-219-7937
  • Fax: 502-219-7948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number246
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number00246
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number244150
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: