Provider Demographics
NPI:1992775191
Name:FRIEDRICH, CHARLES (DO)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:FRIEDRICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9470 HEALTHPARK CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3600
Mailing Address - Country:US
Mailing Address - Phone:239-482-4673
Mailing Address - Fax:239-482-7298
Practice Address - Street 1:9470 HEALTHPARK CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3600
Practice Address - Country:US
Practice Address - Phone:239-482-4673
Practice Address - Fax:239-482-7298
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5709207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038094600Medicaid
FL087535000Medicaid
FLE75975Medicare UPIN
FL101516Medicare ID - Type Unspecified
FL80234ZMedicare ID - Type Unspecified