Healthcare Provider Details

I. General information

NPI: 1417944661
Provider Name (Legal Business Name): JACK A FRIEDLAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 N SCOTTSDALE ROAD SUITE E200
PARADISE VALLEY AZ
85253-5945
US

IV. Provider business mailing address

5233 E ARROYO RD
PARADISE VALLEY AZ
85253-3321
US

V. Phone/Fax

Practice location:
  • Phone: 480-905-1700
  • Fax: 480-505-6429
Mailing address:
  • Phone: 602-617-0000
  • Fax: 602-952-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number5939
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number5939
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: