Provider Demographics
NPI:1447228614
Name:HOWARD, FRED I III (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:I
Last Name:HOWARD
Suffix:III
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 1:451 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-4251
Mailing Address - Country:US
Mailing Address - Phone:863-679-1986
Mailing Address - Fax:863-676-3126
Practice Address - Street 1:451 S 11TH ST
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853
Practice Address - Country:US
Practice Address - Phone:863-679-1986
Practice Address - Fax:863-676-3126
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82331208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020051510OtherMEDICARE ID/RRM PIN
FL261553300Medicaid
FL020051510OtherMEDICARE ID/RRM PIN
FL261553300Medicaid