Provider Demographics
NPI:1922016674
Name:NAGEL, FRED G JR (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:G
Last Name:NAGEL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1701 CLUB MANOR DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-7400
Mailing Address - Country:US
Mailing Address - Phone:501-851-7400
Mailing Address - Fax:501-851-4753
Practice Address - Street 1:1701 CLUB MANOR DR
Practice Address - Street 2:SUITE 2
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-7400
Practice Address - Country:US
Practice Address - Phone:501-851-7400
Practice Address - Fax:501-851-4753
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARC68072207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR113243001Medicaid
AR0904380009Medicare NSC
AR51160Medicare ID - Type Unspecified
AR51160Medicare PIN
AR080062668Medicare PIN
AR113243001Medicaid