Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 018.001690 | IL |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 08794 | IA |
NPI | 1083860985 |
---|---|
Provider Name | Dr. Luke James Freml |
First Address | Des Moines, IA 50321-3105 |
Second Address | Des Moines, IA 50321-3105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2008 |
Last Update Date | 11/07/2012 |