Healthcare Provider Details

I. General information

NPI: 1962548552
Provider Name (Legal Business Name): GARY WILLIAM FRICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 DUNLAWTON AVE STE 1
PORT ORANGE FL
32127-4931
US

IV. Provider business mailing address

804 DUNLAWTON AVE STE 1
PORT ORANGE FL
32127-4931
US

V. Phone/Fax

Practice location:
  • Phone: 386-767-8584
  • Fax: 386-767-8536
Mailing address:
  • Phone: 386-767-8584
  • Fax: 386-767-8536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME73316
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: