Provider Demographics
NPI:1548767239
Name:FREUDENTHAL, ERIC STEVEN (SFIDC)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:STEVEN
Last Name:FREUDENTHAL
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4776 E GUADALUPE RD APT 2044
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-7590
Mailing Address - Country:US
Mailing Address - Phone:904-574-7566
Mailing Address - Fax:
Practice Address - Street 1:4776 E GUADALUPE RD APT 2044
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-7590
Practice Address - Country:US
Practice Address - Phone:904-574-7566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman