Basic Information
| Provider Information | |||||||||
| NPI: | 1083691877 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRIEDLAND | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 E GEDDES AVE | ||||||||
| Address2: | NO 200 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 E HAMPDEN AVE | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801132702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 04/07/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 36954 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 25035 | NE | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 04-36404 | KS | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD17476 | HI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 54255 | TN | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | R1028 | TX | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1083691877 | 05 | SD | MEDICAID | 209903707 | 05 | MO | MEDICAID | 1083691877 | 05 | MT | MEDICAID | 118495400 | 05 | WY | MEDICAID | 3345190 00 | 05 | MD | MEDICAID | 1083691877 | 05 | CA | MEDICAID | 1083691877 | 05 | ID | MEDICAID | 171606001 | 05 | TX | MEDICAID | 200025500A | 05 | OK | MEDICAID | 104686140 | 05 | MI | MEDICAID | 1063691877 | 05 | AL | MEDICAID | 29535280 | 05 | NM | MEDICAID | 84-059792913 | 05 | NE | MEDICAID | 1530353 | 05 | TN | MEDICAID | 02567619 | 05 | NY | MEDICAID | 10025709000 | 05 | NE | MEDICAID | 1083691877 | 05 | IA | MEDICAID | 1083691877 | 05 | ME | MEDICAID | 1083691877 | 05 | MO | MEDICAID | 200025500 A | 05 | OK | MEDICAID | 374786 | 05 | AZ | MEDICAID | 01369545 | 05 | CO | MEDICAID | 1083691877 | 05 | UT | MEDICAID | 200912930 | 05 | IN | MEDICAID | 7617656 | 05 | NC | MEDICAID |