Provider Demographics
NPI:1043218860
Name:BEHRINGER, FREDERICK R JR (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:R
Last Name:BEHRINGER
Suffix:JR
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 1:4651 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-4880
Mailing Address - Country:US
Mailing Address - Phone:813-321-1786
Mailing Address - Fax:813-321-1787
Practice Address - Street 1:2611 SE 17TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5587
Practice Address - Country:US
Practice Address - Phone:352-629-8881
Practice Address - Fax:352-629-1220
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0036163207ND0101X, 207ND0900X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101811900Medicaid
FLD85731Medicare UPIN
FLK0658Medicare ID - Type UnspecifiedGROUP NUMBER
FL42142ZMedicare PIN
FL42142ZMedicare ID - Type UnspecifiedDOCTOR PROVIDER NUMBER