NPIMap

Organization Active NPI

Dwayne Friday, M.D., PLLC

  • Internal Medicine Physician
  • El Paso, TX
National Provider Identifier
1619490133
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
P3150 Issued in TX
Legal business name
DWAYNE FRIDAY, M.D., PLLC
Practice address
811 Chelsea St Ste a
El Paso, TX 79903-4925
Phone
(915) 259-1390
Fax
(888) 824-5635
NPI assigned
Jul 18, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Miss Zelda Thomas
Title
Administrator
Phone
(915) 259-1390

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X P3150 TX Primary

Addresses

Primary practice location

811 Chelsea St Ste a
El Paso, TX 79903-4925

Mailing address

811 Chelsea St Ste a
El Paso, TX 79903-4925
Phone (915) 259-1390

Other identifiers 1

IdentifierTypeStateIssuer
298202701MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170928001216 TX Part B Supplier - Clinic/Group Practice 6002180171 Receives reassigned benefits from 5 practitioners
Practice locations: El Paso, TX

National Provider Directory

National Provider Directory

Locations

113 E Redd Rd
El Paso, TX 79932
Phone (915) 259-1390

811 Chelsea St
#A
El Paso, TX 79903
Phone (915) 259-1390

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1500336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1619490133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 CHELSEA ST STE A",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799034925",
            "telephone_number": "915-259-1390",
            "fax_number": "888-824-5635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 CHELSEA ST STE A",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799034925",
            "telephone_number": "915-259-1390",
            "fax_number": "888-824-5635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DWAYNE FRIDAY, M.D., PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-18",
        "last_updated": "2022-07-21",
        "certification_date": "2021-04-06",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "ZELDA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "915-259-1390",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "P3150",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "298202701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.