Provider Demographics
NPI:1316085343
Name:BARNETT, FRED L (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:L
Last Name:BARNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1997 BARRETT CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2667
Mailing Address - Country:US
Mailing Address - Phone:270-826-3538
Mailing Address - Fax:270-827-2779
Practice Address - Street 1:1997 BARRETT CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2667
Practice Address - Country:US
Practice Address - Phone:270-826-3538
Practice Address - Fax:270-827-2779
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16204208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC74364Medicare UPIN