Basic Information
| Provider Information | |||||||||
| NPI: | 1841237310 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FREER | ||||||||
| FirstName: | KIPTON | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 MODOC PL | ||||||||
| Address2: | |||||||||
| City: | MANITOU SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 808292005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035213594 | ||||||||
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| Practice Location | |||||||||
| Address1: | 179 PARKSIDE DR | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809103130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195726330 | ||||||||
| FaxNumber: | 7194474792 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 40510 | CO | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.