Provider Demographics
NPI:1548555691
Name:FRIDLEY, DONALD ROBERT (DO)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ROBERT
Last Name:FRIDLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7541 MEDICAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6502
Mailing Address - Country:US
Mailing Address - Phone:727-819-9107
Mailing Address - Fax:727-819-9138
Practice Address - Street 1:7541 MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6502
Practice Address - Country:US
Practice Address - Phone:727-819-9107
Practice Address - Fax:727-819-9138
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOTO14323208600000X
FLOS13614208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017833400Medicaid
FL017833400Medicaid