Healthcare Provider Details

I. General information

NPI: 1972705333
Provider Name (Legal Business Name): ISAAC FREEBORN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 E WHATLEY RD
OAKDALE LA
71463-2318
US

IV. Provider business mailing address

PO BOX 5050
OAKDALE LA
71463-5050
US

V. Phone/Fax

Practice location:
  • Phone: 318-335-4070
  • Fax:
Mailing address:
  • Phone: 318-335-4070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD201355
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD201355
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberMD201355
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberMD201355
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberMD201355
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: