Provider Demographics
NPI:1376782920
Name:FREIDENSTEIN, JAMES E (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:FREIDENSTEIN
Suffix:
Gender:M
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:PO BOX 1538
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32004-1538
Mailing Address - Country:US
Mailing Address - Phone:904-800-7246
Mailing Address - Fax:904-299-4116
Practice Address - Street 1:105 WHITEHALL DR STE 115&116
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086
Practice Address - Country:US
Practice Address - Phone:904-800-7246
Practice Address - Fax:904-299-4116
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99398208VP0014X, 207LP2900X, 208VP0014X
NC2011-00945208VP0014X
TN48077208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013841100Medicaid
FL013841100Medicaid
AL118932Medicaid
AL051106024OtherBCBS OF AL
AL051115133OtherBCBS OF AL
AL051106025OtherBCBS OF AL
MS04756891OtherMEDICAID OF MISSISSIPPI
AL051106026OtherBCBS OF AL
AL118930Medicaid
AL126696Medicaid
AL118931Medicaid
AL118932Medicaid