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General NPI Number Information
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NPI Number | 1245298306
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Entity Type | Individual
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Provider Name | GREGORY FUQUA MD
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Gender | Male
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Dates
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Enumeration Date | 05/01/2006
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 202 LIMESTONE ST S STE 1B
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City | FRANKFORT
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State | KY
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Zip | 40601-4320
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Country | US
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Telephone | 502-665-8375
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Fax | 502-665-8376
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Provider Business Mailing Address
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Address Line | PO BOX 776351
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City | CHICAGO
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State | IL
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Zip | 60677-6351
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Country | US
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Telephone | 502-665-8375
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Fax | 502-665-8376
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 29659
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License Number State | KY
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