Healthcare Provider Details

I. General information

NPI: 1063415123
Provider Name (Legal Business Name): ROY FRIEBAND D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 ACADEMY ST
PRESQUE ISLE ME
04769-3102
US

IV. Provider business mailing address

140 ACADEMY ST
PRESQUE ISLE ME
04769-3102
US

V. Phone/Fax

Practice location:
  • Phone: 207-435-6341
  • Fax:
Mailing address:
  • Phone: 207-435-6341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2091
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: