Provider Demographics
NPI:1356382261
Name:FRIDAY, DANNY JOE (PA)
Entity type:Individual
Prefix:MR
First Name:DANNY
Middle Name:JOE
Last Name:FRIDAY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:507 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BEARDSTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62618-1558
Mailing Address - Country:US
Mailing Address - Phone:217-323-2245
Mailing Address - Fax:217-323-1276
Practice Address - Street 1:507 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BEARDSTOWN
Practice Address - State:IL
Practice Address - Zip Code:62618-1558
Practice Address - Country:US
Practice Address - Phone:217-323-2245
Practice Address - Fax:217-323-1276
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0209002403OtherSTATE LIC NUMBER
ILP35289Medicare UPIN