Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | M1685 | TX |
NPI | 1003920224 |
---|---|
Provider Name | Dr. Jonathan Alexander Friedman |
First Address | Bryan, TX 77802-3475 |
Second Address | Bryan, TX 77802-3475 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 30/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
176572902 | (05) | TX |
8U5901 | BLUE CROSS PROVIDER NUMBE (01) | TX |
G70942 | (02) | TX |
P00294339 | MEDICARE RAILROAD (01) | TX |