MEDICARE: DR. JEFFREY CRAIG FRIEDMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	G 46244	CA

General Provider Information

NPI Number	:	1598979734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY CRAIG FRIEDMAN M.D.

Provider Business Mailing Address
First Line	:	12074 BROADWAY TER
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-1957
Country	:	US
Telephone Number	:	510-450-0543
Fax Number	:

Provider Business Practice Location Address
First Line	:	911 MORAGA RD STE 205
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-4500
Country	:	US
Telephone Number	:	925-283-4012
Fax Number	:	925-283-4847

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	07/08/2007

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