Healthcare Provider Details

I. General information

NPI: 1124194568
Provider Name (Legal Business Name): GEORGE EDWARD FREEMAN, D.O.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 E LINCOLN RD SUITE B-1
IDABEL OK
74745-7345
US

IV. Provider business mailing address

1425 E LINCOLN RD SUITE B-1
IDABEL OK
74745-7345
US

V. Phone/Fax

Practice location:
  • Phone: 580-286-4949
  • Fax: 580-286-4946
Mailing address:
  • Phone: 580-286-4949
  • Fax: 580-286-4946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3192
License Number StateOK

VIII. Authorized Official

Name: DR. GEORGE EDWARD FREEMAN
Title or Position: PRESIDENT
Credential: DO
Phone: 580-286-4949