Healthcare Provider Details

I. General information

NPI: 1558699512
Provider Name (Legal Business Name): JOAN BLUM FRIDERICI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2065 NE TUCSON WAY APT 110
BEND OR
97701-5182
US

IV. Provider business mailing address

PO BOX 4228
PORTLAND OR
97208-4228
US

V. Phone/Fax

Practice location:
  • Phone: 541-383-3005
  • Fax: 541-383-1883
Mailing address:
  • Phone: 541-617-5369
  • Fax: 541-323-3866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD195918
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: