Healthcare Provider Details

I. General information

NPI: 1649930223
Provider Name (Legal Business Name): FREEMAN CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2021
Last Update Date: 05/04/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 SOUTHPARK RD STE 101
LAFAYETTE LA
70508-2900
US

IV. Provider business mailing address

151 SOUTHPARK RD STE 101
LAFAYETTE LA
70508-2900
US

V. Phone/Fax

Practice location:
  • Phone: 337-484-1178
  • Fax: 337-534-8311
Mailing address:
  • Phone: 337-484-1178
  • Fax: 337-534-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK E FREEMAN
Title or Position: OWNER/ MEDICAL DIRECTOR
Credential: MD
Phone: 337-484-1178