Provider Demographics
NPI:1407872849
Name:FRIAS, FEDERICO A (MD)
Entity type:Individual
Prefix:MR
First Name:FEDERICO
Middle Name:A
Last Name:FRIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:FEDERICO
Other - Middle Name:A
Other - Last Name:FRIAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5255 OFFICE PARK BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-3443
Mailing Address - Country:US
Mailing Address - Phone:941-755-7000
Mailing Address - Fax:941-755-7088
Practice Address - Street 1:5255 OFFICE PARK BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-3443
Practice Address - Country:US
Practice Address - Phone:941-755-7000
Practice Address - Fax:941-755-7088
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87970208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269271600Medicaid