Healthcare Provider Details

I. General information

NPI: 1598892838
Provider Name (Legal Business Name): WILLIAM H FRIEDMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 N BALLAS RD SUITE 600D
SAINT LOUIS MO
63131-2330
US

IV. Provider business mailing address

3023 N BALLAS RD SUITE 600D
SAINT LOUIS MO
63131-2330
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-4644
  • Fax:
Mailing address:
  • Phone: 314-991-4644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number29636
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: