Healthcare Provider Details

I. General information

NPI: 1871554394
Provider Name (Legal Business Name): FREDERICK JAY FRICKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2006
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

8309 SW 39TH PL
GAINESVILLE FL
32608-3640
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-7770
  • Fax: 352-392-0547
Mailing address:
  • Phone: 352-273-7770
  • Fax: 352-392-0547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME74330
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberME74330
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: