MEDICARE: DR. DAVID R FRIES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	215616	NY
2	207RC0000X	Cardiovascular Disease Physician	ME158793	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043215361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID R FRIES M.D.

Provider Business Mailing Address
First Line	:	3400 QUADRANGLE BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-1492
Country	:	US
Telephone Number	:	407-266-3627
Fax Number	:	407-882-4799

Provider Business Practice Location Address
First Line	:	9975 TAVISTOCK LAKES BLVD STE 360
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32827-7665
Country	:	US
Telephone Number	:	407-266-3627
Fax Number	:	407-266-4911

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	11/07/2023

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Directions to “ DR. DAVID R FRIES M.D.” Practice Location

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