Provider Demographics
NPI:1205841798
Name:BLAKE FRIEDEN, MD, PA
Entity Type:Organization
Organization Name:BLAKE FRIEDEN, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-566-7488
Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:SUITE D-540
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2505
Mailing Address - Country:US
Mailing Address - Phone:972-566-7488
Mailing Address - Fax:972-566-7465
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:SUITE D-540
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:972-566-7488
Practice Address - Fax:972-566-7465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty