Provider Demographics
NPI:1275531394
Name:FRIDAY, RENEE YVETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:YVETTE
Last Name:FRIDAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4659 COHEN AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-4430
Mailing Address - Country:US
Mailing Address - Phone:915-217-1140
Mailing Address - Fax:915-217-1139
Practice Address - Street 1:4659 COHEN AVE UNIT A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-4430
Practice Address - Country:US
Practice Address - Phone:915-217-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6384208000000X
NM91-502080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152156903Medicaid
NM66604397Medicaid