Provider Demographics
NPI:1912901380
Name:FRIDRICH, ROBERT E (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:FRIDRICH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 E WHITEHOUSE CANYON RD STE 170
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-0544
Mailing Address - Country:US
Mailing Address - Phone:520-648-0444
Mailing Address - Fax:520-648-6920
Practice Address - Street 1:518 E WHITEHOUSE CANYON RD 170
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-0544
Practice Address - Country:US
Practice Address - Phone:520-648-0444
Practice Address - Fax:520-648-6920
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ203213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ189812Medicaid
AZDB8932OtherRAILROAD
AZDPM203BMedicare PIN
AZDB8932OtherRAILROAD
AZ0555590002Medicare NSC