MEDICARE: DR. DAVID STEPHEN FREITAG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ND0101X	MOHS-Micrographic Surgery Physician	101044482	VA
2	207ND0101X	MOHS-Micrographic Surgery Physician	ME103242	FL
3	207ND0101X	MOHS-Micrographic Surgery Physician	MD60147325	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	145AU	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053387050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID STEPHEN FREITAG M.D.

Provider Business Mailing Address
First Line	:	29170 POSITANO COURT
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34110-2851
Country	:	US
Telephone Number	:	239-594-3131
Fax Number	:

Provider Business Practice Location Address
First Line	:	26800 S TAMIAMI TRL
Second Line	:	SUITE 360
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-4349
Country	:	US
Telephone Number	:	239-495-1234
Fax Number	:	239-495-2345

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	03/18/2014

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Directions to “ DR. DAVID STEPHEN FREITAG M.D.” Practice Location

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