Provider Demographics
NPI:1740253921
Name:FRIESS, ROBERT C (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:FRIESS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 FOX VIEW CT
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1885
Mailing Address - Country:US
Mailing Address - Phone:419-479-1274
Mailing Address - Fax:
Practice Address - Street 1:5901 MONCLOVA RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1855
Practice Address - Country:US
Practice Address - Phone:419-897-8370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.005552207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0170425Medicaid
OH0727956Medicare PIN