Provider Demographics
NPI:1386612117
Name:FRIDDLE, JOSEPH
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:FRIDDLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:
Other - Last Name:FRIDDLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IDC
Mailing Address - Street 1:PSC 475 BOX 1654
Mailing Address - Street 2:
Mailing Address - City:FPO, AP
Mailing Address - State:CA
Mailing Address - Zip Code:96350-1654
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PSC 475
Practice Address - Street 2:BOX 1654
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96350-1654
Practice Address - Country:JP
Practice Address - Phone:011-843-8821
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1710I1002X1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman