Provider Demographics
NPI:1518942606
Name:FRIEDMAN, NORMAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:R
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1110 HOSPITAL ROAD
Mailing Address - Street 2:DERMATOLOGY DEPARTMENT
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547
Mailing Address - Country:US
Mailing Address - Phone:850-863-8281
Mailing Address - Fax:850-863-8206
Practice Address - Street 1:1110 HOSPITAL ROAD
Practice Address - Street 2:DERMATOLOGY DEPARTMENT
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-863-8281
Practice Address - Fax:850-863-8206
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50335207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049517400Medicaid
FL07613OtherBCBSFL
FL049517400Medicaid
A79021Medicare UPIN