Healthcare Provider Details

I. General information

NPI: 1225000235
Provider Name (Legal Business Name): DR. ROBERT FRIERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S JACKSON ST
LOUISVILLE KY
40202-1622
US

IV. Provider business mailing address

PO BOX 3367
LOUISVILLE KY
40201-3367
US

V. Phone/Fax

Practice location:
  • Phone: 502-588-4425
  • Fax: 502-588-4427
Mailing address:
  • Phone: 502-588-4425
  • Fax: 502-588-4427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number19771
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: