Provider Demographics
NPI:1154441822
Name:FREIDEL, DENISE JEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:JEAN
Last Name:FREIDEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N MORLEY ST STE A
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-2334
Mailing Address - Country:US
Mailing Address - Phone:660-263-1225
Mailing Address - Fax:660-263-1255
Practice Address - Street 1:300 N MORLEY ST STE A
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-2334
Practice Address - Country:US
Practice Address - Phone:660-263-1225
Practice Address - Fax:660-263-1255
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE264207Q00000X
MO2009034588207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE200652429OtherUNITED HEALTHCARE
NE07034OtherBLUE CROSS PROVIDER #
NE200652429Medicaid
NEP00226181OtherRAILROAD MEDICARE
NE20065242968066OtherTRICARE PROVIDER #
NE235965OtherMIDLANDS CHOICE PROVIDER
NE277586Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
NEH55519Medicare UPIN