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General NPI Number Information
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NPI Number | 1952473308
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Entity Type | Individual
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Provider Name | ROBERT ALLEN FRICK DO,DPM,MPH,PT
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Gender | Male
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 03/27/2018
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Provider Practice Location Address
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Address Line | 325TH MEDICAL GROUP 340 MAGNOLIA CIRCLE TYNDALL AFB
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City | PANAMA CITY
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State | FL
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Zip | 32403
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Country | US
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Telephone | 850-283-7281
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Fax |
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Provider Business Mailing Address
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Address Line | 340 MAGNOLIA CIRCLE TYNDALL AFB
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City | PANAMA CITY
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State | FL
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Zip | 32403
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Country | US
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Telephone | 850-283-7281
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A 6345
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License Number State | CA
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