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NPI Code Detail

MEDICARE: MR. CLAUDE RANDALL FRIDLEY

MEDICARE: MR. CLAUDE RANDALL FRIDLEY
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
1363AM0700XMedical Physician AssistantPA 3018FL

General Provider Information

NPI Number : 1720243702
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CLAUDE RANDALL FRIDLEY
Provider Business Mailing Address
First Line : 644 FLORIDA AVE
Second Line : UNIT E
City : PANAMA CITY
State : FL
Zip : 32401-6354
Country : US
Telephone Number : 850-896-0569
Fax Number : 850-522-9155
Provider Business Practice Location Address
First Line : 4419 TRAM RD
Second Line :
City : PANAMA CITY
State : FL
Zip : 32404-2559
Country : US
Telephone Number : 850-747-5825
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2008
Last Update Date : 07/19/2008

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Directions to “ MR. CLAUDE RANDALL FRIDLEY ” Practice Location

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