1962610642 NPI number — JASON C FRIEDRICHS M.D.

Table of content: JASON C FRIEDRICHS M.D. (NPI 1962610642)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962610642 NPI number — JASON C FRIEDRICHS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRIEDRICHS
Provider First Name:
JASON
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962610642
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1806 PRINCESS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34110-1002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-895-3937
Provider Business Mailing Address Fax Number:
815-991-9178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6900 INTERNATIONAL CENTER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33912-7151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-895-3937
Provider Business Practice Location Address Fax Number:
815-991-9178
Provider Enumeration Date:
05/18/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  R-7682 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 036.120383 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)