NPI Code Detail JSON Logo

1760047096 NPI number — TRISTAN BLASE FRIED MD

NPI Number: 1760047096
Health Care Provider/Practitioner: TRISTAN BLASE FRIED MD

Information about “1760047096” NPI (TRISTAN BLASE FRIED MD) exists in 1760047096 in HTML format HTML  |  1760047096 in plain Text format TXT  |  1760047096 in PDF (Portable Document Format) PDF  |  1760047096 in an XML format XML  formats.

NPI Number : 1760047096 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760047096",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FRIED",
    "FirstName": "TRISTAN",
    "MiddleName": "BLASE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1611 W HARRISON ST STE 201",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60612-4861",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "312-563-6306",
    "MailingAddressFaxNumber": "312-942-2040",
    "FirstLinePracticeLocationAddress": "500 ALA MOANA BLVD STE 4-470",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HONOLULU",
    "PracticeLocationAddressStateName": "HI",
    "PracticeLocationAddressPostalCode": "96813-4925",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "808-909-9115",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/02/2019",
    "LastUpdateDate": "09/16/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207XS0117X",
          "TaxonomyName": "Orthopaedic Surgery of the Spine Physician",
          "LicenseNumber": "MD-25682",
          "LicenseNumberStateCode": "HI",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207XS0117X",
          "TaxonomyName": "Orthopaedic Surgery of the Spine Physician",
          "LicenseNumber": "036168181",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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