Provider Demographics
NPI:1649279902
Name:FRIEDMAN, MARK JOEL (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOEL
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:UNIVERSITY OF ARIZONA HEALTH NETWORK
Mailing Address - Street 2:1501 N. CAMPBELL AVE.
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-0001
Mailing Address - Country:US
Mailing Address - Phone:520-629-2763
Mailing Address - Fax:520-626-0967
Practice Address - Street 1:UNIVERSITY OF ARIZONA HEALTH NETWORK
Practice Address - Street 2:1501 N. CAMPBELL AVE.
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-0001
Practice Address - Country:US
Practice Address - Phone:520-629-2763
Practice Address - Fax:520-626-0967
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8918207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100014060AMedicaid
OK241425817Medicare ID - Type Unspecified
D39116Medicare UPIN