Healthcare Provider Details

I. General information

NPI: 1801846423
Provider Name (Legal Business Name): DOUGLAS M FREEDMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 SANTA MONICA BLVD #545E
SANTA MONICA CA
90404-2208
US

IV. Provider business mailing address

2021 SANTA MONICA BLVD #545E
SANTA MONICA CA
90404-2208
US

V. Phone/Fax

Practice location:
  • Phone: 310-828-2042
  • Fax: 310-828-9581
Mailing address:
  • Phone: 310-828-2042
  • Fax: 310-828-9581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberG076414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: