Provider Demographics
NPI:1841316312
Name:F R FRUEHAN FAMILY PRACTICE INC
Entity type:Organization
Organization Name:F R FRUEHAN FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER CREDENTIAL DEPT
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:VANZUUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-445-6191
Mailing Address - Street 1:9 PINECONE DR
Mailing Address - Street 2:STE 102
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137
Mailing Address - Country:US
Mailing Address - Phone:386-445-6191
Mailing Address - Fax:386-445-3916
Practice Address - Street 1:9 PINE CONE DR STE 102
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8683
Practice Address - Country:US
Practice Address - Phone:386-445-6191
Practice Address - Fax:386-445-3916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5359207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B34410Medicare UPIN