Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 35.037521 | OH |
N | 207QA0401X | Family Doctor - Addiction Medicine | 35.037521 | OH |
NPI | 1588643118 |
---|---|
Provider Name | Jerry Alan Friemoth |
First Address | Cincinnati, OH 45267-2827 |
Second Address | Cincinnati, OH 45267 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2006 |
Last Update Date | 02/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0529208 | (05) | OH |
A15856 | (02) |