Healthcare Provider Details

I. General information

NPI: 1265830178
Provider Name (Legal Business Name): FREDERICK TURNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 ROYAL GARDENS CT APT 5
LOUISVILLE KY
40214-4643
US

IV. Provider business mailing address

1007 ROYAL GARDENS CT APT 5
LOUISVILLE KY
40214-4643
US

V. Phone/Fax

Practice location:
  • Phone: 502-333-2652
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: