Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | D0054171 | MD |
NPI | 1003877176 |
---|---|
Provider Name | Dr. Jacob L Friesen |
First Address | Silver Spring, MD 20906-3339 |
Second Address | Bethesda, MD 20889 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2006 |
Last Update Date | 13/09/2012 |