Provider Demographics
NPI:1487634481
Name:FREITAS, DIEGO M (MD)
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:M
Last Name:FREITAS
Suffix:
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 1:12230 LIONESS WAY
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-5603
Mailing Address - Country:US
Mailing Address - Phone:720-644-9355
Mailing Address - Fax:
Practice Address - Street 1:12230 LIONESS WAY
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-5603
Practice Address - Country:US
Practice Address - Phone:720-644-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 85363207R00000X
CO36642207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17392OtherBLUE CROSS BLUE SHIELD FL
FL264811300Medicaid
FL110238857OtherRAILROAD MEDICARE
AL59082835OtherBLUE CROSS BLUE SHIELD AL
FLB809OtherHEALTH FIRST NETWORK
FLG79107Medicare UPIN
FL17392ZMedicare ID - Type Unspecified
CO332636YTUXMedicare PIN