Healthcare Provider Details

I. General information

NPI: 1598979734
Provider Name (Legal Business Name): JEFFREY CRAIG FRIEDMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 MORAGA RD STE 205
LAFAYETTE CA
94549-4500
US

IV. Provider business mailing address

12074 BROADWAY TER
OAKLAND CA
94611-1957
US

V. Phone/Fax

Practice location:
  • Phone: 925-283-4012
  • Fax: 925-283-4847
Mailing address:
  • Phone: 510-450-0543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberG 46244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: