=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275531543
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GREGG LOWELL FRIEDMAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2005
-----------------------------------------------------
Last Update Date | 06/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 EAST HALLANDALE BEACH BLVD SUITE 702
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-4840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-456-1996
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2500 EAST HALLANDALE BEACH BLVD SUITE 702
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-4840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-456-1996
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | ME49447
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------