Provider Demographics
NPI:1033135066
Name:FRIEDMAN, BRADLEY RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:RYAN
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11560 TEEL PKWY
Mailing Address - Street 2:SUITE #100
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4430
Mailing Address - Country:US
Mailing Address - Phone:972-668-0821
Mailing Address - Fax:
Practice Address - Street 1:11560 TEEL PKWY
Practice Address - Street 2:SUITE #100
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4430
Practice Address - Country:US
Practice Address - Phone:972-668-0821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94376207Q00000X
TXM5168207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AN040OtherBLUE CROSS NUMBER
TX8AN040OtherBLUE CROSS NUMBER