1417944661 NPI number — DR. JACK A FRIEDLAND M.D.

Table of content: DR. JACK A FRIEDLAND M.D. (NPI 1417944661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417944661 NPI number — DR. JACK A FRIEDLAND M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRIEDLAND
Provider First Name:
JACK
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417944661
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5233 E ARROYO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARADISE VALLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85253-3321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-617-0000
Provider Business Mailing Address Fax Number:
602-952-1001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5410 N SCOTTSDALE ROAD
Provider Second Line Business Practice Location Address:
SUITE E200
Provider Business Practice Location Address City Name:
PARADISE VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85253-5945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-905-1700
Provider Business Practice Location Address Fax Number:
480-505-6429
Provider Enumeration Date:
10/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  5939 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2082S0099X , with the licence number: 5939 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 201252 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: AZ0779280 . This is a "BC OF ARIZONA ID NUMBER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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