Provider Demographics
NPI:1861484826
Name:FREBERG, DANIEL L (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:FREBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 MADISON 7353
Mailing Address - Street 2:
Mailing Address - City:HINDSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72738-5021
Mailing Address - Country:US
Mailing Address - Phone:602-881-4000
Mailing Address - Fax:602-641-6631
Practice Address - Street 1:1100 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-1944
Practice Address - Country:US
Practice Address - Phone:479-443-4301
Practice Address - Fax:479-587-5929
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ3255207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ447799Medicaid
AZ66160Medicare ID - Type Unspecified
AZ447799Medicaid