MEDICARE: MARK DANIEL FRIEDMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	17039	AZ

General Provider Information

NPI Number	:	1053310599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK DANIEL FRIEDMAN MD

Provider Business Mailing Address
First Line	:	142 W CALLE DE CABALLOS
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85284-2214
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2330 N 75TH AVE
Second Line	:	SUITE 108
City	:	PHOENIX
State	:	AZ
Zip	:	85035-1200
Country	:	US
Telephone Number	:	623-247-5700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	07/08/2007

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