1154328201 NPI number — DR. MARVIN KIRK FREEBURG D,D,S,

Table of content: DR. MARVIN KIRK FREEBURG D,D,S, (NPI 1154328201)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154328201 NPI number — DR. MARVIN KIRK FREEBURG D,D,S,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREEBURG
Provider First Name:
MARVIN
Provider Middle Name:
KIRK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D,D,S,
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154328201
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4010 STONE BROOKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50010-2900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-232-5353
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
137 LYNN AVE
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
AMES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50014-7126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-292-7262
Provider Business Practice Location Address Fax Number:
515-292-7270
Provider Enumeration Date:
07/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  5891 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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