Provider Demographics
NPI:1225022098
Name:FRIEDMAN, LAURANCE JASON (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURANCE
Middle Name:JASON
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:PO BOX 51258
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-5558
Mailing Address - Country:US
Mailing Address - Phone:310-423-8600
Mailing Address - Fax:310-423-0424
Practice Address - Street 1:8700 BEVERLY BLVD.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-1865
Practice Address - Country:US
Practice Address - Phone:310-423-8600
Practice Address - Fax:310-423-0424
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80718207P00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG57015Medicare UPIN
CAWG80718BMedicare PIN