Provider Demographics
NPI:1184638868
Name:FRIEND, CHARLES R (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:FRIEND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-3833
Mailing Address - Country:US
Mailing Address - Phone:352-277-5305
Mailing Address - Fax:352-616-0926
Practice Address - Street 1:3480 DELTONA BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-2917
Practice Address - Country:US
Practice Address - Phone:352-600-7900
Practice Address - Fax:352-600-8994
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10246207Q00000X
IN02001804A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000891732OtherANTHEM
IN200528320Medicaid
INP01368092OtherRAIL ROAD MEDICARE
IN201246920Medicaid
FL5517084OtherAETNA
IN000000371599OtherANTHEM
FL280728900Medicaid
FL14150OtherBCBS
FL14150OtherBCBS
INH12272Medicare UPIN
FL280728900Medicaid
FLAJ036ZMedicare PIN