Provider Demographics
NPI:1720189236
Name:FRIEDBERG, GARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:GARRY
Middle Name:
Last Name:FRIEDBERG
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 1:1400 E OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4400
Mailing Address - Country:US
Mailing Address - Phone:954-564-3223
Mailing Address - Fax:954-564-7149
Practice Address - Street 1:1400 E OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-4400
Practice Address - Country:US
Practice Address - Phone:954-564-3223
Practice Address - Fax:954-564-7149
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54886174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24472Medicare ID - Type Unspecified
FLE22628Medicare UPIN