Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 036122462 | IL |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 48990 | KY |
NPI | 1760599633 |
---|---|
Provider Name | Dr. Robert Allan Fried |
First Address | Cincinnati, OH 45263-6324 |
Second Address | Edgewood, KY 41017-3403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 20/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D60863 | (02) |