Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | F8113 | TX |
NPI | 1003830829 |
---|---|
Provider Name | Lawrie Hilton Friedman |
First Address | Richardson, TX 75080-5477 |
Second Address | Richardson, TX 75080-5477 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 17/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00SE27 | BLUE CROSS (01) | TX |
C15789 | (02) | TX |