Provider Demographics
NPI:1568499713
Name:FRIEDT, BRIAN D (PHYSICIANS ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:D
Last Name:FRIEDT
Suffix:
Gender:M
Credentials:PHYSICIANS ASSISTANT
Other - Prefix:
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Mailing Address - Street 1:1618 S. MILLENNIUM WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6457
Mailing Address - Country:US
Mailing Address - Phone:208-884-3376
Mailing Address - Fax:208-884-0858
Practice Address - Street 1:1618 S. MILLENNIUM WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6457
Practice Address - Country:US
Practice Address - Phone:208-884-3376
Practice Address - Fax:208-884-0858
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2019-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDPA304363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806151500Medicaid
ID806151500Medicaid
IDP22117Medicare UPIN