Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 4009 | AZ |
NPI | 1043435043 |
---|---|
Provider Name | Richard Michael Freimuth |
First Address | Yuma, AZ 85364-8551 |
Second Address | Yuma, AZ 85364-8551 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T88233 | (02) | AZ |