Provider Demographics
NPI:1871554394
Name:FRICKER, FREDERICK JAY (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:JAY
Last Name:FRICKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8309 SW 39TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-3640
Mailing Address - Country:US
Mailing Address - Phone:352-273-7770
Mailing Address - Fax:352-392-0547
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-273-7770
Practice Address - Fax:352-392-0547
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74330208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000748888AMedicaid
FL378890300Medicaid
FL378890300Medicaid
FL68774XMedicare PIN
FL370009682Medicare PIN
C30187Medicare UPIN