Provider Demographics
NPI:1437248994
Name:FREITAS, EDUARDO AUGUSTO FONSECA (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO AUGUSTO
Middle Name:FONSECA
Last Name:FREITAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:611 W FRANCIS ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-0620
Mailing Address - Country:US
Mailing Address - Phone:308-696-8280
Mailing Address - Fax:308-696-8279
Practice Address - Street 1:611 W FRANCIS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-0620
Practice Address - Country:US
Practice Address - Phone:308-696-8280
Practice Address - Fax:308-696-8279
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE24990207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025588700Medicaid
NENA1095075Medicare PIN
NE10025588700Medicaid