Provider Demographics
NPI:1194766956
Name:TOW, FRED (MD)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:TOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 LAKE WORTH RD
Mailing Address - Street 2:STE 204
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3213
Mailing Address - Country:US
Mailing Address - Phone:904-515-6909
Mailing Address - Fax:904-515-6909
Practice Address - Street 1:8921 RAVEN ROCK CT
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33473-4831
Practice Address - Country:US
Practice Address - Phone:941-356-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME584742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378898900Medicaid
FL27962YMedicare PIN
FL27962XMedicare PIN
G19931Medicare UPIN
FLG19931Medicare UPIN
FL378898900Medicaid