1174512107 NPI number — ROBERT H FRIEDMAN MD PA

Table of content: (NPI 1174512107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174512107 NPI number — ROBERT H FRIEDMAN MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT H FRIEDMAN MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1174512107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21376 PROVINCIAL BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KATY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77450-7580
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-578-6868
Provider Business Mailing Address Fax Number:
281-578-6869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21376 PROVINCIAL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KATY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77450-7580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-578-6868
Provider Business Practice Location Address Fax Number:
281-578-6869
Provider Enumeration Date:
10/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FRIEDMAN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER / PHYSICIAN
Authorized Official Telephone Number:
281-578-6868

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  D2423 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X , with the licence number: G12840 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 26584 . This is a "AMERI GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 683630 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 826163120 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P1465520 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0382207 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0096MD . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 035059701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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