Provider Demographics
NPI:1740288810
Name:JUNARD, FREDERICK OLATUNJI (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:OLATUNJI
Last Name:JUNARD
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:PO BOX 110284
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37222
Mailing Address - Country:US
Mailing Address - Phone:615-732-0228
Mailing Address - Fax:615-732-0231
Practice Address - Street 1:393 WALLACE ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211
Practice Address - Country:US
Practice Address - Phone:615-732-0228
Practice Address - Fax:615-732-0231
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2008-01-08
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
TNH35033207R00000X
TN31801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
100178830OtherSIGNATURE
3894234OtherCIGNA COMMERCIAL
621868887OtherCHOICE CARE NETWORK
621868887OtherFIRST HEALTH NETWORK
7740358OtherAETNA
3863238OtherCIGNA
TN3863238Medicaid
4048057OtherBCBS
621868887OtherUHC
930127473OtherRAILROAD MEDICARE
35033OtherHEALTHSPRING
621868887OtherCAMPUS/TRICARE
621868887OtherPHCS NETWORK
TN38632381Medicare PIN
3863238OtherCIGNA