Basic Information
| Provider Information | |||||||||
| NPI: | 1578910261 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FREIDBERG | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8240 N MOPAC EXPY STE 100 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787598869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5126871970 | ||||||||
| FaxNumber: | 5124079010 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 W 38TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124775905 | ||||||||
| FaxNumber: | 5124778640 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2016 | ||||||||
| LastUpdateDate: | 08/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | TP250 | KY | N | Allopathic & Osteopathic Physicians | Urology | 390200000X | TX | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208800000X | T4749 | TX | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.