Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 246 | KY |
Y | 222Z00000X | Podiatrist | 246 | KY |
N | 213EP1101X | Primary Podiatric Medicine | 00246 | KY |
NPI | 1346358843 |
---|---|
Provider Name | Dr. John Wayne Fricker JR. |
First Address | Frankfort, KY 40601-4163 |
Second Address | Frankfort, KY 40601-4163 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2006 |
Last Update Date | 05/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000184063 | ANTHEM (01) | KY |
80002462 | (05) | KY |
P00071331 | RAILROAD MEDICARE (01) | KY |
U73460 | (02) |