Basic Information
| Provider Information | |||||||||
| NPI: | 1013994938 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRIEDMAN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4107 SPICEWOOD SPRINGS RD | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787598660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123973360 | ||||||||
| FaxNumber: | 5123437107 | ||||||||
| Practice Location | |||||||||
| Address1: | 4107 SPICEWOOD SPRINGS RD | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787598660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123973360 | ||||||||
| FaxNumber: | 5123437107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2005 | ||||||||
| LastUpdateDate: | 10/27/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QH0002X | M5713 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 241092 | 05 | AZ | MEDICAID |