=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447330923
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMIE B FRIEDMAN PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2006
-----------------------------------------------------
Last Update Date | 03/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1054 GATEWAY BLVD SUITE 110
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33426-8301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-738-4770
-----------------------------------------------------
Fax | 561-738-9727
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9564 EQUUS CIR
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33472-4334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-306-7999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA9103899
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------