Provider Demographics
NPI:1497842314
Name:FRIEDMAN, SCOTT MAYER (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:MAYER
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 1:2202 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-2908
Mailing Address - Country:US
Mailing Address - Phone:863-682-7474
Mailing Address - Fax:863-802-4587
Practice Address - Street 1:2202 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-2908
Practice Address - Country:US
Practice Address - Phone:863-682-7474
Practice Address - Fax:863-802-4587
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57010207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL051364400Medicaid
F73994Medicare UPIN