Provider Demographics
NPI:1275566929
Name:MORETA FREIRE, ELVIA G (MD)
Entity Type:Individual
Prefix:
First Name:ELVIA
Middle Name:G
Last Name:MORETA FREIRE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2854 HIGHWAY 55 STE 130
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1776
Mailing Address - Country:US
Mailing Address - Phone:651-224-4930
Mailing Address - Fax:651-842-3391
Practice Address - Street 1:2854 HIGHWAY 55 STE 190
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1783
Practice Address - Country:US
Practice Address - Phone:651-644-4277
Practice Address - Fax:651-644-4018
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2022-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN40077207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN570715300Medicaid
G45671Medicare UPIN
MN570715300Medicaid