MEDICARE: PAMELA PHILLIPS FRIYE D.O.

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	207Q00000X	Family Medicine Physician	036-098223	IL
2	207V00000X	Obstetrics & Gynecology Physician	036-098223	IL

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

General Provider Information

NPI Number	:	1639156383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA PHILLIPS FRIYE D.O.

Provider Business Mailing Address
First Line	:	927 BROADWAY ST
Second Line	:
City	:	QUINCY
State	:	IL
Zip	:	62301-2719
Country	:	US
Telephone Number	:	217-224-6423
Fax Number	:	217-223-9172

Provider Business Practice Location Address
First Line	:	927 BROADWAY ST
Second Line	:
City	:	QUINCY
State	:	IL
Zip	:	62301-2719
Country	:	US
Telephone Number	:	217-224-6423
Fax Number	:	217-223-9172

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

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	11/27/2023

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Directions to “ PAMELA PHILLIPS FRIYE D.O.” Practice Location

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