MEDICARE: DR. DANE R FLIEDNER MD

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	208000000X	Pediatrics Physician	M5161	TX
2	208000000X	Pediatrics Physician	A76363	CA

General Provider Information

NPI Number	:	1164568655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANE R FLIEDNER MD

Provider Business Mailing Address
First Line	:	PO BOX 12257
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92658-5057
Country	:	US
Telephone Number	:	949-788-1111
Fax Number	:	949-788-1110

Provider Business Practice Location Address
First Line	:	1601 DOVE ST
Second Line	:	SUITE 276
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2433
Country	:	US
Telephone Number	:	949-788-1111
Fax Number	:	949-788-1110

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	05/05/2021

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