Provider Demographics
NPI:1932191640
Name:FRESCHI, SCOT ALAN (DPM)
Entity Type:Individual
Prefix:
First Name:SCOT
Middle Name:ALAN
Last Name:FRESCHI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:ALAN
Other - Last Name:FRESCHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 1936
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50306-1936
Mailing Address - Country:US
Mailing Address - Phone:515-471-9373
Mailing Address - Fax:
Practice Address - Street 1:3200 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-4104
Practice Address - Country:US
Practice Address - Phone:515-271-1731
Practice Address - Fax:515-271-1692
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00773213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00367975OtherRR MEDICARE
IAI11308Medicare ID - Type Unspecified
U80624Medicare UPIN