Healthcare Provider Details

I. General information

NPI: 1184614653
Provider Name (Legal Business Name): DOUGLAS JOHN FREEL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 HAMPSHIRE ST
QUINCY IL
62301-3027
US

IV. Provider business mailing address

5012 STARBOARD DR
QUINCY IL
62305-8280
US

V. Phone/Fax

Practice location:
  • Phone: 217-222-6550
  • Fax:
Mailing address:
  • Phone: 217-316-1260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number000712
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number016-003720
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: