Healthcare Provider Details

I. General information

NPI: 1770260861
Provider Name (Legal Business Name): MR. DARRYL ALAN FREUDENTHALER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 OAKDALE AVE APT 142
SPRINGFIELD OR
97477-7739
US

IV. Provider business mailing address

887 OAKDALE AVE APT 142
SPRINGFIELD OR
97477-7739
US

V. Phone/Fax

Practice location:
  • Phone: 541-543-4958
  • Fax:
Mailing address:
  • Phone: 541-543-4958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: