Healthcare Provider Details

I. General information

NPI: 1437135464
Provider Name (Legal Business Name): FREEMAN E BROADWELL III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 FLEMING STREET
HENDERSONVILLE NC
28791
US

IV. Provider business mailing address

1027 FLEMING STREET
HENDERSONVILLE NC
28791
US

V. Phone/Fax

Practice location:
  • Phone: 828-692-5781
  • Fax: 828-696-8606
Mailing address:
  • Phone: 828-692-5781
  • Fax: 828-696-8606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number9300394
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: