Provider Demographics
NPI:1366474322
Name:FRIEDMAN, GERALD STANLEY (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:STANLEY
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 1:600 N 13TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4957
Mailing Address - Country:US
Mailing Address - Phone:909-373-1799
Mailing Address - Fax:909-373-0428
Practice Address - Street 1:600 N 13TH AVE
Practice Address - Street 2:STE 100
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4957
Practice Address - Country:US
Practice Address - Phone:909-373-1799
Practice Address - Fax:909-373-0428
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG19835207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G198350Medicaid
A40770Medicare UPIN
CA00G198350Medicaid