Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | IA0102 | IA |
Y | 222Z00000X | Podiatrist | IA0102 | IA |
NPI | 1013998145 |
---|---|
Provider Name | Dr. Bruce H Fridinger |
First Address | Ottumwa, IA 52501-4228 |
Second Address | Ottumwa, IA 52501-4228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2005 |
Last Update Date | 25/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3115741 | (05) | IA |
U45991 | (02) | IA |