Provider Demographics
NPI:1689644064
Name:FRIEDENSTAB, ALLEN PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:PAUL
Last Name:FRIEDENSTAB
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 1:777 37TH ST STE C101
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7301
Mailing Address - Country:US
Mailing Address - Phone:772-562-6566
Mailing Address - Fax:772-562-6570
Practice Address - Street 1:777 37TH ST STE C101
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7301
Practice Address - Country:US
Practice Address - Phone:772-562-6566
Practice Address - Fax:772-562-6570
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46913207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0449OtherMEDICARE GROUP NUMBER
FL160040632OtherRAILROAD MEDICARE
FL62613OtherBLUE CROSS BLUE SHEILD
FL62613OtherBLUE CROSS BLUE SHEILD
FLD57516Medicare UPIN
FL62613XMedicare ID - Type Unspecified