Provider Demographics
NPI:1770260861
Name:FREUDENTHALER, DARRYL ALAN
Entity type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:ALAN
Last Name:FREUDENTHALER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:887 OAKDALE AVE APT 142
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-7739
Mailing Address - Country:US
Mailing Address - Phone:541-543-4958
Mailing Address - Fax:
Practice Address - Street 1:887 OAKDALE AVE APT 142
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-7739
Practice Address - Country:US
Practice Address - Phone:541-543-4958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist