Healthcare Provider Details

I. General information

NPI: 1205197837
Provider Name (Legal Business Name): DAVID FREEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10511 GOLF COURSE RD NW STE 103
ALBUQUERQUE NM
87114-5917
US

IV. Provider business mailing address

10511 GOLF COURSE RD NW STE 103
ALBUQUERQUE NM
87114-5917
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-7281
  • Fax:
Mailing address:
  • Phone: 505-262-7281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number29324
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD2017-0758
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: