Provider Demographics
NPI:1346217072
Name:RASP, FRED L (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:L
Last Name:RASP
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:MEDPARTNERS, ATTN: MEGAN FORTNEY
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3515
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:7952 W JEFFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4140
Practice Address - Country:US
Practice Address - Phone:260-435-2836
Practice Address - Fax:260-435-7585
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01024370A207R00000X
IN01024370208M00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000087415OtherANTHEM
INP00783794OtherRAILROAD MEDICARE
OH0624739Medicaid
IN100355530Medicaid
IN100355530Medicaid
IN260690DDDMedicare PIN
IN100355530Medicaid