Basic Information
Provider Information
NPI: 1215381264
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FREILING
FirstName: TRISTAN
MiddleName: PHILLIP
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 339 CONSORT DR
Address2:  
City: BALLWIN
State: MO
PostalCode: 630114439
CountryCode: US
TelephoneNumber: 6363869224
FaxNumber: 6362004243
Practice Location
Address1: 615 S NEW BALLAS RD
Address2:  
City: SAINT LOUIS
State: MO
PostalCode: 631418221
CountryCode: US
TelephoneNumber: 6363869224
FaxNumber: 6362004243
Other Information
ProviderEnumerationDate: 04/15/2016
LastUpdateDate: 06/11/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/11/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X2021013176MOY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


Home