Healthcare Provider Details

I. General information

NPI: 1811379605
Provider Name (Legal Business Name): ERIC WILLIAM FREILER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BELLE TERRE PKWY STE 112
PALM COAST FL
32164-2315
US

IV. Provider business mailing address

800 BELLE TERRE PKWY STE 112
PALM COAST FL
32164-2315
US

V. Phone/Fax

Practice location:
  • Phone: 386-777-7311
  • Fax: 386-777-7312
Mailing address:
  • Phone: 386-777-7311
  • Fax: 386-777-7312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number25MD00353200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO4114
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: