Provider Demographics
NPI:1831148147
Name:FRIEDLAND, JAMES T (M D)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:FRIEDLAND
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 PINE CANYON DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-1266
Mailing Address - Country:US
Mailing Address - Phone:928-699-5474
Mailing Address - Fax:
Practice Address - Street 1:7600 PINE CANYON DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1266
Practice Address - Country:US
Practice Address - Phone:928-699-5474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME223362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037373700Medicaid
FL037373700Medicaid