Provider Demographics
NPI:1083751457
Name:FREDERICK L. YERBY, M.D., P.C.
Entity Type:Organization
Organization Name:FREDERICK L. YERBY, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:YERBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-932-7750
Mailing Address - Street 1:1716 TEMPLE AVE N
Mailing Address - Street 2:SUITE 6
Mailing Address - City:FAYETTE
Mailing Address - State:AL
Mailing Address - Zip Code:35555-1309
Mailing Address - Country:US
Mailing Address - Phone:205-932-7750
Mailing Address - Fax:205-932-6293
Practice Address - Street 1:1716 TEMPLE AVE N
Practice Address - Street 2:SUITE 6
Practice Address - City:FAYETTE
Practice Address - State:AL
Practice Address - Zip Code:35555-1309
Practice Address - Country:US
Practice Address - Phone:205-932-7750
Practice Address - Fax:205-932-6293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15356207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000084451Medicaid
AL000084451OtherBCBS
000084451Medicare ID - Type Unspecified
AL000084451Medicaid