Provider Demographics
NPI:1962571067
Name:FRIDIE, DAVID H II (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:FRIDIE
Suffix:II
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3820
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78540
Mailing Address - Country:US
Mailing Address - Phone:956-318-1010
Mailing Address - Fax:956-381-5857
Practice Address - Street 1:2808 FOUNTAIN PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-318-1010
Practice Address - Fax:956-381-5857
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1177207Q00000X, 208600000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110401003Medicaid
TX00G44YMedicare ID - Type Unspecified
TX110401003Medicaid