Healthcare Provider Details

I. General information

NPI: 1821089699
Provider Name (Legal Business Name): JEFFREY FRIEDMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 N SPRING GARDEN AVE
DELAND FL
32720-2560
US

IV. Provider business mailing address

154 STANDISH DR
ORMOND BEACH FL
32176-4751
US

V. Phone/Fax

Practice location:
  • Phone: 386-736-1948
  • Fax: 386-736-2784
Mailing address:
  • Phone: 386-299-2546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS0005813
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: