Healthcare Provider Details

I. General information

NPI: 1962573576
Provider Name (Legal Business Name): BRIAN D. FREETO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3273 CLAREMONT WAY SUITE 100
NAPA CA
94558-3306
US

IV. Provider business mailing address

PO BOX 2059
NAPA CA
94558-2908
US

V. Phone/Fax

Practice location:
  • Phone: 707-254-7117
  • Fax: 707-265-6435
Mailing address:
  • Phone: 707-254-7117
  • Fax: 707-265-6435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number47240-020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA107982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: