Provider Demographics
NPI:1134197486
Name:FREID, EUGENE B (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:B
Last Name:FREID
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 1:110 S SERENATA DR UNIT 412
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32082-4574
Mailing Address - Country:US
Mailing Address - Phone:904-368-6578
Mailing Address - Fax:
Practice Address - Street 1:110 S SERENATA DR UNIT 412
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32082-4574
Practice Address - Country:US
Practice Address - Phone:904-368-6578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-12
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93075207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA384615513AMedicaid
FL272479100Medicaid
GA384615513AMedicaid
U5044AMedicare PIN