Provider Demographics
NPI:1598979734
Name:FRIEDMAN, JEFFREY CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CRAIG
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 1:12074 BROADWAY TER
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-1957
Mailing Address - Country:US
Mailing Address - Phone:510-450-0543
Mailing Address - Fax:
Practice Address - Street 1:911 MORAGA RD STE 205
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4500
Practice Address - Country:US
Practice Address - Phone:925-283-4012
Practice Address - Fax:925-283-4847
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG 46244261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical