Provider Demographics
NPI:1144488875
Name:FRYKBERG, BRETT P (MD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:P
Last Name:FRYKBERG
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 1:1325 SAN MARCO BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8566
Mailing Address - Country:US
Mailing Address - Phone:904-346-3465
Mailing Address - Fax:904-396-0388
Practice Address - Street 1:1325 SAN MARCO BLVD STE 200
Practice Address - Street 2:CREDENTIALING DEPARTMENT
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8566
Practice Address - Country:US
Practice Address - Phone:904-346-3465
Practice Address - Fax:904-396-0388
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119733207X00000X
NY268211207XS0114X
FLTRN12339390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012810500Medicaid
FLP01366905OtherRAILROAD MEDICARE
FLHW654ZMedicare PIN