Doctor Name: | DR. JACOB L FRIESEN |
NPI Number: | 1003877176 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | D0054171 |
Business Practice Address: | 8901 Wisconsin Ave Wrnmmc, Nicoe, Building 51 Bethesda, MD - 20889 |
Business Phone Number: | 3013193772 |
Business Fax Number: | |
Mailing Address: | 12732 Middlevale Ln, SILVER SPRING |
State: | MD |
Postal Code: | 209063339 |
Phone Number: | 3018738145 |
Fax Number: | |
NPI Enumeration Date: | 03/29/2006 |
NPI Last Update Date: | 09/13/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | D0054171 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MD |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |