Healthcare Provider Details

I. General information

NPI: 1205894417
Provider Name (Legal Business Name): DAVID H FREEMAN PA/FNP MPAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/22/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 5TH ST
GONZALES CA
93926
US

IV. Provider business mailing address

200 CORPORATE LAKE DR
COLUMBIA MO
65203-7172
US

V. Phone/Fax

Practice location:
  • Phone: 831-675-2930
  • Fax:
Mailing address:
  • Phone: 831-276-0411
  • Fax: 270-594-4317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberFNP 709
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12303
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: