Provider Demographics
NPI:1114908597
Name:FROEHLY, BERTRAM MARTIN JR (MD)
Entity Type:Individual
Prefix:
First Name:BERTRAM
Middle Name:MARTIN
Last Name:FROEHLY
Suffix:JR
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 1:3660 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3912
Mailing Address - Country:US
Mailing Address - Phone:951-782-6218
Mailing Address - Fax:951-784-3266
Practice Address - Street 1:7117 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2615
Practice Address - Country:US
Practice Address - Phone:951-782-6218
Practice Address - Fax:951-784-3266
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG329762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ3188Z7ZOtherGROUP SITE NUMBER
ZZZ3188Z7ZOtherGROUP SITE NUMBER
A45368Medicare UPIN