Provider Demographics
NPI:1609977768
Name:REGENSTEIN, FREDRIC GARY (MD)
Entity Type:Individual
Prefix:
First Name:FREDRIC
Middle Name:GARY
Last Name:REGENSTEIN
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 1:1430 TULANE AVE
Mailing Address - Street 2:# 8535
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2632
Mailing Address - Country:US
Mailing Address - Phone:816-932-7940
Mailing Address - Fax:816-932-7957
Practice Address - Street 1:4320 WORNALL RD
Practice Address - Street 2:SUITE 240
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5941
Practice Address - Country:US
Practice Address - Phone:816-932-7900
Practice Address - Fax:816-932-7920
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07834R207RI0008X
MOR9479207RT0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009942107Medicaid
AL009913256Medicaid
MO1609977768Medicaid
MS05978098Medicaid
LA1380890Medicaid
LA55104D867Medicare PIN
AL009942107Medicaid
MOW19000078Medicare PIN