Provider Demographics
NPI:1275531394
Name:FRIDAY, RENEE YVETTE (MD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:YVETTE
Last Name:FRIDAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 1ST ST STE 707
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6500
Mailing Address - Country:US
Mailing Address - Phone:254-247-7659
Mailing Address - Fax:915-217-1139
Practice Address - Street 1:700 1ST ST STE 707
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6500
Practice Address - Country:US
Practice Address - Phone:254-247-7659
Practice Address - Fax:575-377-8254
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM9150208000000X
TXL6384208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152156903Medicaid
NM66604397Medicaid