Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 3620 | MN |
Y | 213ER0200X | Radiology | 3620 | MN |
NPI | 1578683462 |
---|---|
Provider Name | Stephen Lee Fridinger |
First Address | Woodbury, MN 55129-5291 |
Second Address | Woodbury, MN 55129-5291 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 24/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
096293700 | (05) | MN |
375T8FR | BC-BS (01) | MN |
U97018 | (02) | MN |