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General NPI Number Information
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NPI Number | 1609254531
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Entity Type | Organization
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Legal Business Name | JOHN C. FRIEDL, INC
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Dates
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Enumeration Date | 05/12/2015
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Last Update Date | 05/12/2015
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Provider Practice Location Address
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Address Line | 13809 S CASPER ST STE D
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City | GLENPOOL
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State | OK
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Zip | 74033-2619
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Country | US
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Telephone | 918-291-2323
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Fax | 918-291-2320
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Provider Business Mailing Address
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Address Line | 13809 S CASPER ST STE D
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City | GLENPOOL
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State | OK
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Zip | 74033-2619
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Country | US
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Telephone | 918-291-2323
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Fax | 918-291-2320
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Authorized Official
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Title or Position | DOCTOR/PRESIDENT
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Name | DR. JOHN C FRIEDL
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Credential | DO
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Telephone | 918-291-2323
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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 | 2743
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License Number State | OK
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