Provider Demographics
NPI:1073591384
Name:FRERICHS, JOHN LINDLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LINDLEY
Last Name:FRERICHS
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 1:4925 N NEVADA AVE
Mailing Address - Street 2:ROOM 416
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918
Mailing Address - Country:US
Mailing Address - Phone:719-425-0933
Mailing Address - Fax:
Practice Address - Street 1:4925 N NEVADA AVE
Practice Address - Street 2:ROOM 416
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918
Practice Address - Country:US
Practice Address - Phone:719-425-0933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47452208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO27408876Medicaid
MN134938400Medicaid
I38044Medicare UPIN
CO27408876Medicaid