Provider Demographics
NPI:1689652927
Name:FROEDGE, JERRY K (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:K
Last Name:FROEDGE
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 1:418 3RD ST NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-5129
Mailing Address - Country:US
Mailing Address - Phone:828-322-8031
Mailing Address - Fax:
Practice Address - Street 1:240 18TH STREET CIR SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1361
Practice Address - Country:US
Practice Address - Phone:828-322-2550
Practice Address - Fax:828-322-7748
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19598208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19598OtherNC MEDICAL LICENSE
NC8934035Medicaid
NC34035OtherBCBS
NC19598OtherNC MEDICAL LICENSE