Provider Demographics
NPI:1679552855
Name:FRIED, JANE D (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:D
Last Name:FRIED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:DURANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7007 BANDERA RD
Mailing Address - Street 2:STE. 19
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1138
Mailing Address - Country:US
Mailing Address - Phone:210-680-6000
Mailing Address - Fax:210-680-9153
Practice Address - Street 1:7007 BANDERA RD
Practice Address - Street 2:STE. 19
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1138
Practice Address - Country:US
Practice Address - Phone:210-680-6000
Practice Address - Fax:210-680-9153
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF44389208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1679552855OtherNPI
TX890102OtherBCBS
TX890102OtherBCBS
TXF44389Medicare UPIN