Individual
MR. JACK MICHAEL FRIDAY
Active
Individual
MR. JACK MICHAEL FRIDAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD25800
TN
2085R0204X
Vascular & Interventional Radiology Physician
25800
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1509266
MEDICAID - MTI
TN
05
—
1509266
—
TN
01
—
300108653
RAILROAD MEDICARE
TN
01
—
3031174
BCBS
TN
05
—
3083732
—
TN
01
—
3136571
BCBS
TN
01
—
4200799
BCBS TN
TN
01
—
4291356
BCBS - MTI
TN
01
—
64924590
KY MEDICAID
KY
05
—
6492459000
—
KY
Enumeration date
06/05/2006
Last updated
11/30/2011
Update your record
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