Provider Demographics
NPI:1790893600
Name:FRIEDMAN, JENNIFER DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:DIANE
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2900 E 29TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2623
Mailing Address - Country:US
Mailing Address - Phone:979-776-8440
Mailing Address - Fax:979-776-6905
Practice Address - Street 1:2900 E 29TH ST STE 200
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2623
Practice Address - Country:US
Practice Address - Phone:979-776-8440
Practice Address - Fax:979-776-6905
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2621207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184131402Medicaid