Provider Demographics
NPI:1700848157
Name:FRIEDLANDER, GARY NEAL (DPM)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:NEAL
Last Name:FRIEDLANDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5352 E ESTEVAN RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-7211
Mailing Address - Country:US
Mailing Address - Phone:602-938-3600
Mailing Address - Fax:602-938-0400
Practice Address - Street 1:5750 W THUNDERBIRD RD STE G700
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306
Practice Address - Country:US
Practice Address - Phone:602-938-3600
Practice Address - Fax:602-938-0400
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0196213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ700064Medicaid
AZ0633230002Medicare NSC
AZZ130330Medicare PIN