Individual
GREGORY FUQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
202 LIMESTONE ST S STE 1B, FRANKFORT, KY 40601-4320
(502) 665-8375
(502) 665-8376
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 665-8375
(502) 665-8376
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
29659
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34296593
—
KY
05
—
64296593
—
KY
Enumeration date
05/01/2006
Last updated
11/27/2024
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