Healthcare Provider Details

I. General information

NPI: 1902946478
Provider Name (Legal Business Name): PHOEBE ELIZABETH FREER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

4404A LACLEDE AVE
SAINT LOUIS MO
63108-2204
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-1935
  • Fax:
Mailing address:
  • Phone: 314-477-4981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2003012201
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: