Healthcare Provider Details

I. General information

NPI: 1912051038
Provider Name (Legal Business Name): JOANNE FRUTH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 OBERLIN RD SUITE 200
RALEIGH NC
27605-1300
US

IV. Provider business mailing address

815 OBERLIN RD SUITE 200
RALEIGH NC
27605-1300
US

V. Phone/Fax

Practice location:
  • Phone: 919-322-4722
  • Fax: 919-322-4729
Mailing address:
  • Phone: 919-322-4722
  • Fax: 919-322-4729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number94-00800
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: