Provider Demographics
NPI:1952307878
Name:AUBERT, FRED E JR (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:E
Last Name:AUBERT
Suffix:JR
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 1:1106 HOSPITAL RD
Mailing Address - Street 2:NEUROSCIENCE CENTER
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6742
Mailing Address - Country:US
Mailing Address - Phone:850-863-8169
Mailing Address - Fax:850-863-7045
Practice Address - Street 1:1106 HOSPITAL RD
Practice Address - Street 2:NEUROSCIENCE CENTER
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6742
Practice Address - Country:US
Practice Address - Phone:850-863-8169
Practice Address - Fax:850-863-7045
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME964332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276151300Medicaid
FL56335OtherBCBSFL
FLH31878Medicare UPIN
FLU8490ZMedicare PIN