Provider Demographics
NPI:1134334105
Name:FREIDL, KATHRYN BURLEIGH (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:BURLEIGH
Last Name:FREIDL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:ELIZABETH
Other - Last Name:BURLEIGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11945 SAN JOSE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1627
Mailing Address - Country:US
Mailing Address - Phone:904-396-1725
Mailing Address - Fax:904-396-4893
Practice Address - Street 1:11512 LAKE MEAD AVE
Practice Address - Street 2:SUITE 534
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9680
Practice Address - Country:US
Practice Address - Phone:904-564-2020
Practice Address - Fax:904-518-3297
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110709207W00000X
NY251737207W00000X
PAMT188861207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFI568YMedicare PIN