Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207ND0101X | MOHS-Micrographic Surgeon | 101044482 | VA |
N | 207ND0101X | MOHS-Micrographic Surgeon | MD60147325 | WA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | ME103242 | FL |
NPI | 1053387050 |
---|---|
Provider Name | Dr. David Stephen Freitag |
First Address | Naples, FL 34110-2851 |
Second Address | Bonita Springs, FL 34134-4349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 18/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004044200 | (05) | FL |
145AU | BCBS (01) | FL |
E23139 | (02) |