Provider Demographics
NPI:1952473308
Name:FRICK, ROBERT ALLEN (DO,DPM,MPH,PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLEN
Last Name:FRICK
Suffix:
Gender:M
Credentials:DO,DPM,MPH,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 MAGNOLIA CIRCLE
Mailing Address - Street 2:TYNDALL AFB
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32403
Mailing Address - Country:US
Mailing Address - Phone:850-283-7281
Mailing Address - Fax:
Practice Address - Street 1:325TH MEDICAL GROUP 340 MAGNOLIA CIRCLE
Practice Address - Street 2:TYNDALL AFB
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32403
Practice Address - Country:US
Practice Address - Phone:850-283-7281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A 6345207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine