Provider Demographics
NPI:1164568655
Name:FLIEDNER, DANE R (MD)
Entity Type:Individual
Prefix:DR
First Name:DANE
Middle Name:R
Last Name:FLIEDNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 12257
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-5057
Mailing Address - Country:US
Mailing Address - Phone:949-788-1111
Mailing Address - Fax:949-788-1110
Practice Address - Street 1:1601 DOVE ST
Practice Address - Street 2:SUITE 276
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2433
Practice Address - Country:US
Practice Address - Phone:949-788-1111
Practice Address - Fax:949-788-1110
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5161208000000X
CAA76363208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8W7239OtherBCBS