Provider Demographics
NPI:1821006990
Name:FRIEDMAN, EDWARD B JR
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:B
Last Name:FRIEDMAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX C
Mailing Address - Street 2:1013 FIRST STREET
Mailing Address - City:REDFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:50233-0903
Mailing Address - Country:US
Mailing Address - Phone:515-833-2301
Mailing Address - Fax:515-833-2108
Practice Address - Street 1:1013 1ST ST
Practice Address - Street 2:
Practice Address - City:REDFIELD
Practice Address - State:IA
Practice Address - Zip Code:50233-1007
Practice Address - Country:US
Practice Address - Phone:515-833-2301
Practice Address - Fax:515-833-2108
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
IA000602363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
163827Medicare Oscar/Certification