Healthcare Provider Details

I. General information

NPI: 1639104466
Provider Name (Legal Business Name): FRED LOUIS SPECK JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 JUNCTION HWY
KERRVILLE TX
78028-4202
US

IV. Provider business mailing address

401 JUNCTION HWY
KERRVILLE TX
78028-4202
US

V. Phone/Fax

Practice location:
  • Phone: 830-896-2810
  • Fax: 830-896-2824
Mailing address:
  • Phone: 830-896-2810
  • Fax: 830-896-2824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberE8928
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: