Provider Demographics
NPI:1851401509
Name:FRIEDERICH, RONALD L (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:L
Last Name:FRIEDERICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1235 WYOMING BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-5044
Mailing Address - Country:US
Mailing Address - Phone:505-292-2220
Mailing Address - Fax:505-292-0920
Practice Address - Street 1:1235 WYOMING BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-5044
Practice Address - Country:US
Practice Address - Phone:505-292-2220
Practice Address - Fax:505-292-0920
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM78150207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180001581OtherMEDICARE RAILROAD
NM000975OtherBLUE CROSS BLUE SHIELD
201003253OtherPRESBYTERIAN HEALTH PLAN
180001581OtherMEDICARE RAILROAD
C97776Medicare UPIN