Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | G24923 | CA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | G24923 | CA |
NPI | 1154351625 |
---|---|
Provider Name | Marc J Friedman |
First Address | Van Nuys, CA 91405-3796 |
Second Address | Van Nuys, CA 91405-3796 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 20/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A42446 | (02) | CA |