Healthcare Provider Details

I. General information

NPI: 1871583211
Provider Name (Legal Business Name): DAVID ALLAN FREEMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49725 COUNTY 83
STAPLES MN
56479-5280
US

IV. Provider business mailing address

49725 COUNTY 83
STAPLES MN
56479-5280
US

V. Phone/Fax

Practice location:
  • Phone: 218-894-1515
  • Fax: 218-894-1316
Mailing address:
  • Phone: 218-894-1515
  • Fax: 218-894-1316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30100
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: