Healthcare Provider Details

I. General information

NPI: 1588643118
Provider Name (Legal Business Name): JERRY ALAN FRIEMOTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 ALBERT SABIN WAY
CINCINNATI OH
45267
US

IV. Provider business mailing address

231 ALBERT SABIN WAY
CINCINNATI OH
45267-2827
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-4457
  • Fax: 513-584-2222
Mailing address:
  • Phone: 513-584-4457
  • Fax: 513-584-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number35.037521
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.037521
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: