Provider Demographics
NPI:1760480206
Name:EPSTEIN, FREDERICK B (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:B
Last Name:EPSTEIN
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 1:1326 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-1974
Mailing Address - Country:US
Mailing Address - Phone:850-265-1769
Mailing Address - Fax:850-265-1769
Practice Address - Street 1:1326 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-1974
Practice Address - Country:US
Practice Address - Phone:850-265-1769
Practice Address - Fax:850-265-1769
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44447207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME44447OtherLICENSE
FL94361OtherBCBSF GRP# 98513
FL069269700Medicaid
FL606478700OtherDOL GRP#
FL94361ZMedicare ID - Type UnspecifiedGRP# 98513
FLD31348Medicare UPIN