Healthcare Provider Details

I. General information

NPI: 1114908597
Provider Name (Legal Business Name): BERTRAM MARTIN FROEHLY JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7117 BROCKTON AVE
RIVERSIDE CA
92506-2615
US

IV. Provider business mailing address

3660 ARLINGTON AVE
RIVERSIDE CA
92506-3912
US

V. Phone/Fax

Practice location:
  • Phone: 951-782-6218
  • Fax: 951-784-3266
Mailing address:
  • Phone: 951-782-6218
  • Fax: 951-784-3266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberG32976
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: