Provider Demographics
NPI:1124337621
Name:FREIJAT, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:FREIJAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MAJD
Other - Middle Name:
Other - Last Name:ALFREIJAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9941 N. 95TH STREET SUITE E101
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4609
Mailing Address - Country:US
Mailing Address - Phone:480-613-3569
Mailing Address - Fax:480-350-7872
Practice Address - Street 1:7425 E SHEA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6411
Practice Address - Country:US
Practice Address - Phone:480-613-3569
Practice Address - Fax:480-350-7872
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47624207R00000X, 207RR0500X
IN01083564A207RR0500X
CAA144931208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ008047Medicaid
IN300035749Medicaid