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General NPI Number Information
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NPI Number | 1518014729
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Entity Type | Individual
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Provider Name | JOHN C FRIEDL D.O.
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Gender | Male
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 03/07/2012
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Provider Practice Location Address
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Address Line | 205 E RAY FINE BLVD SUITE 6
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City | ROLAND
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State | OK
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Zip | 74954-5380
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Country | US
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Telephone | 918-503-6235
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Fax | 918-398-0637
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Provider Business Mailing Address
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Address Line | 12605 S ELWOOD AVE
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City | JENKS
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State | OK
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Zip | 74037-2814
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Country | US
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Telephone | 918-296-0654
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Fax | 918-398-0637
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | N-8164
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | N-8164
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | N-8164
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License Number State | AR
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