Basic Information
| Provider Information | |||||||||
| NPI: | 1710935838 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRIEZE | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1055 N 300 W STE 303 | ||||||||
| Address2: | |||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846043373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013561300 | ||||||||
| FaxNumber: | 8013561304 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 N TRIUMPH BLVD STE 260 | ||||||||
| Address2: | |||||||||
| City: | LEHI | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840434999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017683531 | ||||||||
| FaxNumber: | 8017683506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 03/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 11352803-1205 | UT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.