Healthcare Provider Details

I. General information

NPI: 1043138126
Provider Name (Legal Business Name): JACOB JAMES FRIE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 HOSPITAL AVE
DU BOIS PA
15801-1442
US

IV. Provider business mailing address

2846 CARRIBEAN ROAD
DUBOIS PA
15801
US

V. Phone/Fax

Practice location:
  • Phone: 814-375-6379
  • Fax: 814-372-2535
Mailing address:
  • Phone: 570-862-4066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: