Healthcare Provider Details

I. General information

NPI: 1528022019
Provider Name (Legal Business Name): ALEX B FRUIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S MOUNT JULIET RD STE 230
MT JULIET TN
37122-3923
US

IV. Provider business mailing address

410 42ND AVE N STE 400
NASHVILLE TN
37209-3658
US

V. Phone/Fax

Practice location:
  • Phone: 615-874-9667
  • Fax: 615-871-9682
Mailing address:
  • Phone: 615-329-7887
  • Fax: 615-292-5722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD0000039848
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: