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NPI Code Detail

MEDICARE: JEFFRY SCOTT FREEMAN PA

MEDICARE: JEFFRY SCOTT FREEMAN PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant5601003249MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1070C910440OTHERMIBLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number : 1285745950
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFRY SCOTT FREEMAN PA
Provider Business Mailing Address
First Line : 3000 OLD CENTRE RD
Second Line :
City : PORTAGE
State : MI
Zip : 49024-4883
Country : US
Telephone Number : 269-321-7546
Fax Number : 269-321-1705
Provider Business Practice Location Address
First Line : 3000 OLD CENTRE RD
Second Line :
City : PORTAGE
State : MI
Zip : 49024-4883
Country : US
Telephone Number : 269-321-7546
Fax Number : 269-321-1705
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 06/03/2014

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Directions to “ JEFFRY SCOTT FREEMAN PA” Practice Location

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