Frederic Fries Bahnson III, M.D.
Individual provider Active NPI Specialist · Brevard, NC
NPI 1801899299 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1801899299
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 18599 (NC)
- Practice address
- 188 Medical Park Drive
Suite B
Brevard, NC 28712 - Phone
- (828) 884-6702
- Fax
- (828) 884-6925
- NPI assigned
- May 31, 2005
- Reactivated
- Mar 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 18599 | NC | Yes |
Addresses
Primary practice location
188 Medical Park Drive
Suite B
Brevard, NC 28712
Mailing address
188 Medical Park Drive
Suite B
Brevard, NC 28712
Phone (828) 884-6702
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8910409 | Medicaid | NC | |
| 1007740 | Other | NC | UNITED HEALTH CARE |
| 10409 | Other | NC | BLUE CROSS BLUE SHIELD |
| 80389 | Other | NC | MEDCOST |
Other providers in Brevard, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.