Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 30474 | AZ |
NPI | 1215931050 |
---|---|
Provider Name | David Jay Friedman |
First Address | Charlotte, NC 28260-3725 |
Second Address | Oro Valley, AZ 85755-9102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 28/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H80676 | (02) | AZ |
Z110191 | MEDICARE PTAN (01) | AZ |