Individual
JARED FRIDLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
PROVIDER ENROLLMENT DEPARTMENT, 117 ELLENFIELD STREET, SUITE 101, PROVIDENCE, RI 02905
(401) 793-9197
Mailing address
1709 DRYDEN RD, HOUSTON, TX 77030-2400
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
MD15268
RI
Other
Enumeration date
01/14/2010
Last updated
11/25/2022
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