Provider Demographics
NPI:1114259876
Name:FRIEDMAN, GARY ALAN (IDMT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:ALAN
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3458 NEELY RD
Mailing Address - Street 2:
Mailing Address - City:MCGUIRE AFB
Mailing Address - State:NJ
Mailing Address - Zip Code:08641
Mailing Address - Country:US
Mailing Address - Phone:937-689-9208
Mailing Address - Fax:
Practice Address - Street 1:3458 NEELY RD
Practice Address - Street 2:
Practice Address - City:MCGUIRE AFB
Practice Address - State:NJ
Practice Address - Zip Code:08641
Practice Address - Country:US
Practice Address - Phone:937-689-9208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians