Healthcare Provider Details

I. General information

NPI: 1396278198
Provider Name (Legal Business Name): JAMES DEAN FREE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 KINGSLEY AVE
ORANGE PARK FL
32073-5148
US

IV. Provider business mailing address

1120 ROUTE 73 STE 300
MOUNT LAUREL NJ
08054-5113
US

V. Phone/Fax

Practice location:
  • Phone: 904-639-2579
  • Fax: 904-639-8730
Mailing address:
  • Phone: 800-442-8938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0102207248
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS15995
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: