Provider Demographics
NPI:1699031377
Name:FRED NORDQUIST, MD, PC
Entity type:Organization
Organization Name:FRED NORDQUIST, MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:NORDQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:615-746-8872
Mailing Address - Street 1:6294 HIGHWAY 41A
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37146-8175
Mailing Address - Country:US
Mailing Address - Phone:615-746-8872
Mailing Address - Fax:615-746-8871
Practice Address - Street 1:6294 HIGHWAY 41A
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:TN
Practice Address - Zip Code:37146-8175
Practice Address - Country:US
Practice Address - Phone:615-746-8872
Practice Address - Fax:615-746-8871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38308207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty