Healthcare Provider Details

I. General information

NPI: 1528150083
Provider Name (Legal Business Name): CHARLES G. FREEMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 US HIGHWAY 61 SUITE 340
FESTUS MO
63028-4100
US

IV. Provider business mailing address

1400 US HIGHWAY 61 SUITE 340
FESTUS MO
63028-4100
US

V. Phone/Fax

Practice location:
  • Phone: 636-937-1545
  • Fax: 636-937-8995
Mailing address:
  • Phone: 636-937-1545
  • Fax: 636-937-8995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberR9916
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: