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General NPI Number Information
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NPI Number | 1942289996
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Entity Type | Individual
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Provider Name | PETER D FRIES MD
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Gender | Male
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Dates
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Enumeration Date | 01/10/2006
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 2160 S 1ST AVE
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 708-216-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 777 TANGLEFOOT LN
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City | BETTENDORF
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State | IA
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Zip | 52722-1650
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Country | US
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Telephone | 563-323-2020
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Fax | 563-328-5694
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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 | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | 036082456
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 28136
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | 28136
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License Number State | IA
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Taxonomy #4
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 036082456
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License Number State | IL
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