Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 6795 | FL |
NPI | 1053441717 |
---|---|
Provider Name | Roger E Freilich |
First Address | Palm Beach Gardens, FL 33410-3338 |
Second Address | Palm Beach Gardens, FL 33410-3338 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 18/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
59-2050698 | TAX ID# (01) | FL |
T55231 | (02) | FL |