Provider Demographics
NPI:1417060419
Name:FRIED, HERBERT IRA (MD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:IRA
Last Name:FRIED
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 1:4591 TULE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-2747
Mailing Address - Country:US
Mailing Address - Phone:720-323-5855
Mailing Address - Fax:
Practice Address - Street 1:4591 TULE LAKE DR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-2747
Practice Address - Country:US
Practice Address - Phone:720-323-5855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23936207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01239367Medicaid
CO307440Medicare PIN
CO31961Medicare ID - Type Unspecified
CO01239367Medicaid