Provider Demographics
NPI:1053387050
Name:FREITAG, DAVID STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:STEPHEN
Last Name:FREITAG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29170 POSITANO COURT
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-2851
Mailing Address - Country:US
Mailing Address - Phone:239-594-3131
Mailing Address - Fax:
Practice Address - Street 1:26800 S TAMIAMI TRL
Practice Address - Street 2:SUITE 360
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4349
Practice Address - Country:US
Practice Address - Phone:239-495-1234
Practice Address - Fax:239-495-2345
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101044482207ND0101X
FLME103242207ND0101X
WAMD60147325207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL145AUOtherBCBS
FL004044200Medicaid
FL145AUOtherBCBS
FL004044200Medicaid