Healthcare Provider Details

I. General information

NPI: 1891197273
Provider Name (Legal Business Name): RYAN FREIBERT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 TURFWAY RD
FLORENCE KY
41042-1375
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-655-8980
  • Fax: 859-655-8981
Mailing address:
  • Phone: 859-655-8980
  • Fax: 859-655-8981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04167
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number04167
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: