Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2009005984 | MO |
NPI | 1164768503 |
---|---|
Provider Name | Dr. Dennis Frerking |
First Address | Branson, MO 65616-8349 |
Second Address | Branson, MO 65616-8349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2012 |
Last Update Date | 12/12/2012 |