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General NPI Number Information
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NPI Number | 1558798405
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Entity Type | Organization
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Legal Business Name | NORTHEAST FLORIDA PSYCHIATRIC ASSOCIATION, INC
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Dates
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Enumeration Date | 10/07/2013
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 804 DUNLAWTON AVE STE 1
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City | PORT ORANGE
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State | FL
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Zip | 32127-4931
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Country | US
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Telephone | 386-767-8584
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Fax | 386-767-8536
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Provider Business Mailing Address
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Address Line | 804 DUNLAWTON AVE STE 1
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City | PORT ORANGE
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State | FL
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Zip | 32127-4931
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Country | US
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Telephone | 386-767-8584
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Fax | 386-767-8536
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Authorized Official
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Title or Position | PROVIDER
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Name | GARY FRICK
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Credential | MD
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Telephone | 386-767-8584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME73316
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License Number State | FL
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