Provider Demographics
NPI:1639104466
Name:SPECK, FRED LOUIS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:LOUIS
Last Name:SPECK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 JUNCTION HWY
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4202
Mailing Address - Country:US
Mailing Address - Phone:830-896-2810
Mailing Address - Fax:830-896-2824
Practice Address - Street 1:401 JUNCTION HWY
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4202
Practice Address - Country:US
Practice Address - Phone:830-896-2810
Practice Address - Fax:830-896-2824
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8928207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035352601Medicaid
TX035352601Medicaid
TXB26600Medicare UPIN