Healthcare Provider Details

I. General information

NPI: 1649273327
Provider Name (Legal Business Name): EDWARD L FRIEDLAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 CREIGHTON RD STE 1
PENSACOLA FL
32504-7152
US

IV. Provider business mailing address

PO BOX 11037
PENSACOLA FL
32524-1037
US

V. Phone/Fax

Practice location:
  • Phone: 850-444-4700
  • Fax: 850-434-8144
Mailing address:
  • Phone: 850-444-4700
  • Fax: 850-444-7497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD.22503
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME76760
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: