Provider Demographics
NPI:1043387244
Name:VINSON, FREDERICK L (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:L
Last Name:VINSON
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:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:FLORESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78114-0658
Mailing Address - Country:US
Mailing Address - Phone:210-392-9266
Mailing Address - Fax:
Practice Address - Street 1:8508 US HIGHWAY 181 N STE B
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-6482
Practice Address - Country:US
Practice Address - Phone:830-393-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5508207V00000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099587003Medicaid
FLK2521Medicare ID - Type Unspecified