Provider Demographics
NPI:1417939315
Name:FRIEDMAN, BRUCE C (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:C
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 16187
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30919-2187
Mailing Address - Country:US
Mailing Address - Phone:706-504-4651
Mailing Address - Fax:706-504-4639
Practice Address - Street 1:3651 WHEELER RD
Practice Address - Street 2:BURN CENTER
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6521
Practice Address - Country:US
Practice Address - Phone:706-504-4651
Practice Address - Fax:706-504-4639
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040066207RC0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG40066Medicaid
GA000666982FMedicaid
GA000666982EMedicaid
GA202I814315Medicare PIN
GA11BDQRXMedicare PIN
GA000666982EMedicaid