Provider Demographics
NPI:1699952465
Name:FRIESEN, DARRIN SCOTT (MD)
Entity type:Individual
Prefix:
First Name:DARRIN
Middle Name:SCOTT
Last Name:FRIESEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 S BRENTWOOD BLVD
Mailing Address - Street 2:SUITE 857
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1315
Mailing Address - Country:US
Mailing Address - Phone:314-968-2111
Mailing Address - Fax:314-968-2139
Practice Address - Street 1:1750 S BRENTWOOD BLVD
Practice Address - Street 2:SUITE 857
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-1315
Practice Address - Country:US
Practice Address - Phone:314-968-2111
Practice Address - Fax:314-968-2139
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106376174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist