Healthcare Provider Details

I. General information

NPI: 1992683528
Provider Name (Legal Business Name): BLAKE EDWARD FREEMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8025 GRAND AVE
WEST DES MOINES IA
50266-5360
US

IV. Provider business mailing address

17107 BLUE SAGE LN
URBANDALE IA
50323-2791
US

V. Phone/Fax

Practice location:
  • Phone: 515-271-1569
  • Fax:
Mailing address:
  • Phone: 563-340-8844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number140760
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: