Bradley Robert Freidel, D.O.
Individual provider Active NPI Internal Medicine Physician · Macon, MO
NPI 1184744765 · NPPES record last updated Jan 10, 2013
Key facts
- NPI
- 1184744765
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 324 (NE)
- Practice address
- 1201 N Rutherford St
Macon, MO 63552-2020 - Phone
- (660) 385-8900
- Fax
- (660) 385-8708
- NPI assigned
- Mar 29, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 324 | NE | MD | Skilled Nursing Facility |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midwest Heart and Vein Center, LLC | Past | Accepting new patients | |
| Moberly Medical Clinics Inc | Past | Accepting new patients | |
| Pegasus Emergency Group Moberly | Past | Accepting new patients | |
| Freidel Medical Associates | Family Medicine | Past | Accepting new patients |
| Wahoo Medical P.C. | Past | Accepting new patients | |
| Ozarks Medical Center | Family Medicine | Past | Accepting new patients |
| Moberly Medical Clinics Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 324 | NE | Yes |
Addresses
Primary practice location
1201 N Rutherford St
Macon, MO 63552-2020
Mailing address
1201 N Rutherford St
Macon, MO 63552-2020
Phone (660) 385-8900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07035 | Other | NE | BLUE CROSS PROVIDER # |
| 20065242968066 | Other | NE | TRICARE PROVIDER |
| 235966 | Other | NE | MIDLANDS CHOICE |
| 200652429 | Other | NE | UNITED HEALTHCARE |
| P00128031 | Other | MT | RAILROAD MEDICARE |
| 200652429 | Medicaid | NE |
Other providers in Macon, MO
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- Family Foot Clinic LLC
- Christopher A Froman
- Iris Ladawn Gaerditz
- Lucy Gaston
- Laurie Gilchrist
- Del Gene Gregory
All providers in Macon, MO · Internal Medicine Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 10, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.