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General NPI Number Information
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NPI Number | 1619490133
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Entity Type | Organization
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Legal Business Name | DWAYNE FRIDAY, M.D., PLLC
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 811 CHELSEA ST STE A
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City | EL PASO
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State | TX
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Zip | 79903-4925
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Country | US
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Telephone | 915-259-1390
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Fax | 888-824-5635
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Provider Business Mailing Address
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Address Line | 811 CHELSEA ST STE A
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City | EL PASO
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State | TX
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Zip | 79903-4925
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Country | US
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Telephone | 915-259-1390
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Fax | 888-824-5635
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MISS ZELDA THOMAS
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Credential |
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Telephone | 915-259-1390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | P3150
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License Number State | TX
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