Provider Demographics
NPI:1255934105
Name:PELFREY, FRED
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:PELFREY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3066 SPRINGFIELD XENIA RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45506-3924
Mailing Address - Country:US
Mailing Address - Phone:937-408-2678
Mailing Address - Fax:
Practice Address - Street 1:3066 SPRINGFIELD XENIA RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45506-3924
Practice Address - Country:US
Practice Address - Phone:937-408-2678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1202737376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker