Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | SP 139 | CA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | SP139 | CA |
NPI | 1154536845 |
---|---|
Provider Name | Earl George Freymiller |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-1668 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 26/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D00139 | (05) | CA |
U32775 | (02) | CA |