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Individual

MR. DANNY JOE FRIDAY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
507 WASHINGTON ST, BEARDSTOWN, IL 62618-1558
(217) 323-2245
(217) 323-1276
Mailing address
507 WASHINGTON ST, BEARDSTOWN, IL 62618-1558
(217) 323-2245
(217) 323-1276

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0209002403
STATE LIC NUMBER
IL
Enumeration date
06/10/2006
Last updated
07/08/2007
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