Healthcare Provider Details

I. General information

NPI: 1467046565
Provider Name (Legal Business Name): FREEDOM WOUND PHYSICIANS FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 N UNIVERSITY DR
TAMARAC FL
33321-2913
US

IV. Provider business mailing address

PO BOX 3409
PFLUGERVILLE TX
78691-3409
US

V. Phone/Fax

Practice location:
  • Phone: 512-202-3830
  • Fax: 512-354-1106
Mailing address:
  • Phone: 513-252-7792
  • Fax: 513-904-5908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HAN PHAM HULEN
Title or Position: MD
Credential: MD
Phone: 513-252-7792