Provider Demographics
NPI:1013998145
Name:FRIDINGER, BRUCE H (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:H
Last Name:FRIDINGER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 N SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-4228
Mailing Address - Country:US
Mailing Address - Phone:641-683-7901
Mailing Address - Fax:641-682-1158
Practice Address - Street 1:520 N SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-4228
Practice Address - Country:US
Practice Address - Phone:641-683-7901
Practice Address - Fax:641-682-1158
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA0102213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3115741Medicaid
IAU45991Medicare UPIN
IA480020312Medicare PIN
IA1173250001Medicare NSC