Healthcare Provider Details

I. General information

NPI: 1497751283
Provider Name (Legal Business Name): DOUGLAS FREEDBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2005
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8630 E VIA DE VENTURA STE 201
SCOTTSDALE AZ
85258-3326
US

IV. Provider business mailing address

PO BOX 29870
PHOENIX AZ
85038-9870
US

V. Phone/Fax

Practice location:
  • Phone: 480-558-3744
  • Fax: 480-558-3801
Mailing address:
  • Phone: 602-772-3800
  • Fax: 602-772-3801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number27374
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: