Healthcare Provider Details

I. General information

NPI: 1417957259
Provider Name (Legal Business Name): GEORGE EDWARD FREEMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 E LINCOLN RD SUITE B1
IDABEL OK
74745-7345
US

IV. Provider business mailing address

1425 E LINCOLN RD SUITE B1
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:
Title or Position:
Credential:
Phone: