Healthcare Provider Details

I. General information

NPI: 1821193947
Provider Name (Legal Business Name): JOHN BRYANT FREER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 W ANTELOPE DR SUITE 100
LAYTON UT
84041-1160
US

IV. Provider business mailing address

PO BOX 110429
AURORA CO
80042-0429
US

V. Phone/Fax

Practice location:
  • Phone: 801-773-8644
  • Fax: 801-927-1591
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number311823-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberDR.0070091
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: