Provider Demographics
NPI:1871615880
Name:FRIEDBERG, SCOTT L (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:L
Last Name:FRIEDBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6611 W BOYNTON BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3526
Mailing Address - Country:US
Mailing Address - Phone:561-369-2428
Mailing Address - Fax:561-369-2429
Practice Address - Street 1:6611 W BOYNTON BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3526
Practice Address - Country:US
Practice Address - Phone:561-369-2428
Practice Address - Fax:561-369-2429
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267565000Medicaid
FLU1577AMedicare ID - Type Unspecified
FL267565000Medicaid