Provider Demographics
NPI:1346245164
Name:FRIESS, RICHARD W (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:FRIESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 STANFORD CT
Mailing Address - Street 2:UNIT 701
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-4813
Mailing Address - Country:US
Mailing Address - Phone:239-566-7425
Mailing Address - Fax:239-593-3430
Practice Address - Street 1:2355 STANFORD CT
Practice Address - Street 2:UNIT 701
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-4813
Practice Address - Country:US
Practice Address - Phone:239-566-7425
Practice Address - Fax:239-593-3430
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD0731207Q00000X
FLLL800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5604654Medicaid
SDP00008245Medicare PIN
SD080195400Medicare PIN
SDD25276Medicare UPIN
SDS40950Medicare PIN