MEDICARE: DR. ERNEST L FRIERSON 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	207Q00000X	Family Medicine Physician	ME0032715	FL
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	ME0032715	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	207855	OTHER	FL	AVMED
2	62201T	OTHER	FL	BLUE CROSS/BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	6510763	OTHER	FL	CIGNA
5	4605660	OTHER	FL	AETNA
6	225755	OTHER	FL	WELLCARE
7	000125095	OTHER	FL	HUMANA

General Provider Information

NPI Number	:	1841306651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERNEST L FRIERSON MD

Provider Business Mailing Address
First Line	:	10051 5TH STREET NORTH #200
Second Line	:
City	:	ST. PETERSBURG
State	:	FL
Zip	:	33702-3001
Country	:	US
Telephone Number	:	727-824-0780
Fax Number	:	727-568-6011

Provider Business Practice Location Address
First Line	:	8950 DR. MARTIN LUTHER KING JR. STREET NORTH
Second Line	:	#180
City	:	ST. PETERSBURG
State	:	FL
Zip	:	33702-3001
Country	:	US
Telephone Number	:	727-576-8900
Fax Number	:	727-570-9045

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	03/12/2014

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