Provider Demographics
NPI:1821567868
Name:REGINAL, FREDERICK BERNARD
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:BERNARD
Last Name:REGINAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 HIGHWAY 80 W
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-2354
Mailing Address - Country:US
Mailing Address - Phone:769-251-1106
Mailing Address - Fax:769-251-1106
Practice Address - Street 1:2310 HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-2354
Practice Address - Country:US
Practice Address - Phone:769-251-1106
Practice Address - Fax:769-251-1106
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health