Provider Demographics
NPI:1366417974
Name:FRIEZE, MARK S (PA)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:S
Last Name:FRIEZE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1701 WESTCHESTER DR
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7008
Mailing Address - Country:US
Mailing Address - Phone:336-802-2145
Mailing Address - Fax:336-802-2536
Practice Address - Street 1:1701 WESTCHESTER DR
Practice Address - Street 2:SUITE 850
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7008
Practice Address - Country:US
Practice Address - Phone:336-802-2145
Practice Address - Fax:336-802-2536
Is Sole Proprietor?:No
Enumeration Date:2006-02-18
Last Update Date:2014-09-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA2914363A00000X
NC103004363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2907950-00Medicaid
GA555833823BMedicaid
FLE0993UMedicare PIN
FLS59248Medicare UPIN
GA555833823BMedicaid