=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891747069
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMUEL FRIEDMAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2006
-----------------------------------------------------
Last Update Date | 04/26/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | GUAM MEDICAL PLAZA 633 GOV. CARLOS CAMACHO RD. STE B5
-----------------------------------------------------
City | TAMUNING
-----------------------------------------------------
State | GU
-----------------------------------------------------
Zip | 96913-3194
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 671-647-4656
-----------------------------------------------------
Fax | 671-647-4660
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | GUAM MEDICAL PLAZA 633 GOV. CARLOS CAMACHO RD. STE B5
-----------------------------------------------------
City | TAMUNING
-----------------------------------------------------
State | GU
-----------------------------------------------------
Zip | 96913-3194
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 671-647-4656
-----------------------------------------------------
Fax | 671-647-4660
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | M001476
-----------------------------------------------------
License Number State | GU
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | MD 00033258
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | G20360
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------