Provider Demographics
NPI:1043215361
Name:FRIES, DAVID R (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:FRIES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3400 QUADRANGLE BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-1492
Mailing Address - Country:US
Mailing Address - Phone:407-266-3627
Mailing Address - Fax:407-882-4799
Practice Address - Street 1:9975 TAVISTOCK LAKES BLVD STE 360
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7665
Practice Address - Country:US
Practice Address - Phone:407-266-3627
Practice Address - Fax:407-266-4911
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2023-11-07
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Provider Licenses
StateLicense IDTaxonomies
NY215616207RC0000X
FLME158793207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118928300Medicaid
NY02523233Medicaid
NY02523233Medicaid