MEDICARE: DR. FREDERICK JAY PRIZANT DPM

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	213E00000X	Podiatrist	36002142	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	160203	OTHER		ANTHEM BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548339666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK JAY PRIZANT DPM

Provider Business Mailing Address
First Line	:	1100 N ABBE RD
Second Line	:	SUITE D
City	:	ELYRIA
State	:	OH
Zip	:	44035-1667
Country	:	US
Telephone Number	:	440-365-2502
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 N ABBE RD
Second Line	:	SUITE D
City	:	ELYRIA
State	:	OH
Zip	:	44035-1667
Country	:	US
Telephone Number	:	440-365-2502
Fax Number	:

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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