Provider Demographics
NPI:1316142532
Name:DOUGLAS B FREEDBERG MD PC
Entity type:Organization
Organization Name:DOUGLAS B FREEDBERG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:FREEDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-558-3744
Mailing Address - Street 1:6929 N HAYDEN RD STE C4 PMB 497
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-7970
Mailing Address - Country:US
Mailing Address - Phone:480-558-3744
Mailing Address - Fax:
Practice Address - Street 1:5111 N SCOTTSDALE RD STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-7007
Practice Address - Country:US
Practice Address - Phone:480-558-3744
Practice Address - Fax:480-558-3801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27374207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG81754Medicare UPIN
AZZ100586Medicare PIN