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NPI Code Detail

MEDICARE: DR. FRED WILLIAM THEYE PHD

MEDICARE:  DR. FRED WILLIAM THEYE  PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103G00000XClinical NeuropsychologistPY 6904FL

General Provider Information

NPI Number : 1679537625
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FRED WILLIAM THEYE PHD
Provider Business Mailing Address
First Line : 850 NW FEDERAL HWY STE 170
Second Line :
City : STUART
State : FL
Zip : 34994-1019
Country : US
Telephone Number : 772-985-0116
Fax Number :
Provider Business Practice Location Address
First Line : 13416 HARBOUR RIDGE BLVD
Second Line :
City : PALM CITY
State : FL
Zip : 34990-4814
Country : US
Telephone Number : 772-644-6456
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2006
Last Update Date : 07/30/2024

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Directions to “ DR. FRED WILLIAM THEYE PHD” Practice Location

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