Provider Demographics
NPI:1760549307
Name:FRIEDMAN, JAY MAX (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:MAX
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 1:1536 N 115TH ST
Mailing Address - Street 2:STE. 300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8400
Mailing Address - Country:US
Mailing Address - Phone:206-368-5457
Mailing Address - Fax:206-368-0622
Practice Address - Street 1:1536 N 115TH ST
Practice Address - Street 2:STE. 300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8400
Practice Address - Country:US
Practice Address - Phone:206-368-5457
Practice Address - Fax:206-368-0622
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030235207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7089325Medicaid
WA39422OtherDEPT OF LABOR AND INDUSTR
WA3840FROtherREGENCE INSURANCE ID NUM
WAFR2864OtherREGENCE INSURANCE ID NUM
WA06400OtherREGENCE INSURANCE ID NUM
WAFR9432OtherREGENCE INSURANCE ID NUM
WA06400OtherREGENCE INSURANCE ID NUM
WA7089325Medicaid
WAFR9432OtherREGENCE INSURANCE ID NUM