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NPI Code Detail

MEDICARE: MR. BRIAN PAUL FREELAND PA-C

MEDICARE: MR. BRIAN PAUL FREELAND PA-C
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 Assistant
2363AS0400XSurgical Physician Assistant1100OK

General Provider Information

NPI Number : 1760540413
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRIAN PAUL FREELAND PA-C
Provider Business Mailing Address
First Line : 919 COLONY DR
Second Line :
City : ADA
State : OK
Zip : 74820-2329
Country : US
Telephone Number : 580-235-0299
Fax Number : 580-235-0297
Provider Business Practice Location Address
First Line : 919 COLONY DR
Second Line :
City : ADA
State : OK
Zip : 74820-2329
Country : US
Telephone Number : 580-235-0299
Fax Number : 580-235-0297
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2006
Last Update Date : 08/27/2020

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