Provider Demographics
NPI:1962497651
Name:CORPUZ, FREDERICK B (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:B
Last Name:CORPUZ
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 1:1840 CAPITAL MEDICAL COURT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4468
Mailing Address - Country:US
Mailing Address - Phone:850-878-0550
Mailing Address - Fax:850-878-0587
Practice Address - Street 1:1840 CAPITAL MEDICAL COURT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4468
Practice Address - Country:US
Practice Address - Phone:850-878-0550
Practice Address - Fax:850-878-0587
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0073516207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252877100Medicaid
FL252877100Medicaid
FL41409ZMedicare PIN