Healthcare Provider Details

I. General information

NPI: 1134334105
Provider Name (Legal Business Name): KATHRYN BURLEIGH FREIDL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN ELIZABETH BURLEIGH M.D.

II. Dates (important events)

Enumeration Date: 05/13/2007
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11512 LAKE MEAD AVE SUITE 534
JACKSONVILLE FL
32256-9680
US

IV. Provider business mailing address

11945 SAN JOSE BLVD STE 300
JACKSONVILLE FL
32223-1627
US

V. Phone/Fax

Practice location:
  • Phone: 904-564-2020
  • Fax: 904-518-3297
Mailing address:
  • Phone: 904-396-1725
  • Fax: 904-396-4893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME110709
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: