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General NPI Number Information
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NPI Number | 1306164223
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Entity Type | Individual
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Provider Name | MARK ALEXANDER FRUENDT D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2010
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 3319C MEMORIAL PKWY SW
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City | HUNTSVILLE
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State | AL
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Zip | 35801-5342
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Country | US
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Telephone | 256-489-5838
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Fax | 256-489-5830
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Provider Business Mailing Address
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Address Line | 2060 RESCUE RD
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City | UNION GROVE
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State | AL
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Zip | 35175-5130
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Country | US
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Telephone | 256-542-2084
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L.3347R
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License Number State | AL
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