Healthcare Provider Details

I. General information

NPI: 1841391786
Provider Name (Legal Business Name): DAVID FREEMAN GREGORY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CERRILLOS RD
SANTA FE NM
87505-3554
US

IV. Provider business mailing address

42 ENTRADA RT 10 BOX 121
SANTA FE NM
87507
US

V. Phone/Fax

Practice location:
  • Phone: 505-946-9273
  • Fax:
Mailing address:
  • Phone: 505-474-6172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberNM79-168
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: