Provider Demographics
NPI:1841306651
Name:FRIERSON, ERNEST L (MD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:L
Last Name:FRIERSON
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 1:10051 5TH STREET NORTH #200
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-3001
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:727-568-6011
Practice Address - Street 1:8950 DR. MARTIN LUTHER KING JR. STREET NORTH
Practice Address - Street 2:#180
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-3001
Practice Address - Country:US
Practice Address - Phone:727-576-8900
Practice Address - Fax:727-570-9045
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0032715207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL207855OtherAVMED
FL62201TOtherBLUE CROSS/BLUE SHIELD
FL263854100Medicaid
FL6510763OtherCIGNA
FL4605660OtherAETNA
FL225755OtherWELLCARE
FL000125095OtherHUMANA
FL6510763OtherCIGNA
FL225755OtherWELLCARE
FL263854100Medicaid