Healthcare Provider Details

I. General information

NPI: 1124001052
Provider Name (Legal Business Name): CHRISTOPHER PAUL FRIESEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 GRAVOIS RD SUITE B
FENTON MO
63026-4131
US

IV. Provider business mailing address

320 GRAVOIS RD SUITE B
FENTON MO
63026-4131
US

V. Phone/Fax

Practice location:
  • Phone: 636-305-1899
  • Fax: 636-305-1898
Mailing address:
  • Phone: 636-305-1899
  • Fax: 636-305-1898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR9450
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: