Provider Demographics
NPI:1225000235
Name:FRIERSON, ROBERT
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:FRIERSON
Suffix:
Gender:M
Credentials:
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 3367
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-3367
Mailing Address - Country:US
Mailing Address - Phone:502-588-4425
Mailing Address - Fax:502-588-4427
Practice Address - Street 1:550 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1622
Practice Address - Country:US
Practice Address - Phone:502-588-4425
Practice Address - Fax:502-588-4427
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY197712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64197718Medicaid
IN200080900Medicaid
IN200080900Medicaid
KY0060213Medicare PIN
KY64197718Medicaid