Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | J7489 | TX |
NPI | 1003928235 |
---|---|
Provider Name | Mr. Joel G Freitag |
First Address | Waco, TX 76712-6689 |
Second Address | Waco, TX 76712-6689 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 15/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F26769 | (02) |