Healthcare Provider Details

I. General information

NPI: 1952622797
Provider Name (Legal Business Name): JOSIAH DAVID FREEMYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 JOEL DR
FORT CAMPBELL KY
42223
US

IV. Provider business mailing address

1216 BIG PINE DR
VALRICO FL
33596-6192
US

V. Phone/Fax

Practice location:
  • Phone: 270-798-8407
  • Fax: 915-569-2652
Mailing address:
  • Phone: 816-872-4924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number01071014A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: