Provider Demographics
NPI:1124001052
Name:FRIESEN, CHRISTOPHER PAUL (DO)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:PAUL
Last Name:FRIESEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:320 GRAVOIS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-4131
Mailing Address - Country:US
Mailing Address - Phone:636-305-1899
Mailing Address - Fax:636-305-1898
Practice Address - Street 1:320 GRAVOIS RD
Practice Address - Street 2:SUITE B
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-4131
Practice Address - Country:US
Practice Address - Phone:636-305-1899
Practice Address - Fax:636-305-1898
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR9450207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000003003Medicare ID - Type Unspecified
E21721Medicare UPIN