1841306651 NPI number — DR. ERNEST L FRIERSON MD

Table of content: DR. ERNEST L FRIERSON MD (NPI 1841306651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841306651 NPI number — DR. ERNEST L FRIERSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRIERSON
Provider First Name:
ERNEST
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1841306651
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10051 5TH STREET NORTH #200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST. PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33702-3001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-824-0780
Provider Business Mailing Address Fax Number:
727-568-6011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8950 DR. MARTIN LUTHER KING JR. STREET NORTH
Provider Second Line Business Practice Location Address:
#180
Provider Business Practice Location Address City Name:
ST. PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33702-3001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-576-8900
Provider Business Practice Location Address Fax Number:
727-570-9045
Provider Enumeration Date:
08/22/2006

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: 207Q00000X , with the licence number:  ME0032715 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207QG0300X , with the licence number: ME0032715 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 207855 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 62201T . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 263854100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6510763 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4605660 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 225755 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 000125095 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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