Provider Demographics
NPI:1073611687
Name:FREITAG, BRETON CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:BRETON
Middle Name:CHARLES
Last Name:FREITAG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:501 N GRAHAM STREET
Mailing Address - Street 2:SUITE 265
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227
Mailing Address - Country:US
Mailing Address - Phone:503-282-7002
Mailing Address - Fax:503-280-1294
Practice Address - Street 1:501 N GRAHAM STREET
Practice Address - Street 2:SUITE 265
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227
Practice Address - Country:US
Practice Address - Phone:503-282-7002
Practice Address - Fax:503-280-1294
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD215832080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286457Medicaid