Provider Demographics
NPI:1255778189
Name:FRIES, IAN BLAIR (MD)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:BLAIR
Last Name:FRIES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 HIGHWAY A1A
Mailing Address - Street 2:FRIES PROFESSIONAL BUILDING
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-2310
Mailing Address - Country:US
Mailing Address - Phone:732-801-8139
Mailing Address - Fax:
Practice Address - Street 1:1480 HIGHWAY A1A
Practice Address - Street 2:FRIES PROFESSIONAL BUILDING
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-2310
Practice Address - Country:US
Practice Address - Phone:732-801-8139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-01
Last Update Date:2013-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0064060207X00000X
NJMA 032823207X00000X
NC97-00430207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery