Provider Demographics
NPI:1487861589
Name:BRADLEY FRIEDMAN M.D. P.A.
Entity Type:Organization
Organization Name:BRADLEY FRIEDMAN M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-668-0821
Mailing Address - Street 1:11560 TEEL PKWY
Mailing Address - Street 2:SUITE #100
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4430
Mailing Address - Country:US
Mailing Address - Phone:972-668-0821
Mailing Address - Fax:
Practice Address - Street 1:11560 TEEL PKWY
Practice Address - Street 2:SUITE #100
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4430
Practice Address - Country:US
Practice Address - Phone:972-668-0821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5168261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0095QCOtherBLUE CROSS NUMBER
TX00Y063Medicare PIN