Provider Demographics
NPI:1003803255
Name:AESTHETIC SURGEONS OF ARIZONA, P.C.
Entity Type:Organization
Organization Name:AESTHETIC SURGEONS OF ARIZONA, P.C.
Other - Org Name:JACK A. FRIEDLAND, M.D., P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRIEDLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-257-8480
Mailing Address - Street 1:101 E CORONADO RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1512
Mailing Address - Country:US
Mailing Address - Phone:602-257-8480
Mailing Address - Fax:602-257-0050
Practice Address - Street 1:101 E CORONADO RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1512
Practice Address - Country:US
Practice Address - Phone:602-257-8480
Practice Address - Fax:602-257-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0200850OtherBC OF AZ PROVIDER #
AZ101785Medicare ID - Type Unspecified