Healthcare Provider Details

I. General information

NPI: 1336375740
Provider Name (Legal Business Name): HOWARD ULYSSES FREEMAN JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9415 CROSS PLAINS CT
HOUSTON TX
77095-2797
US

IV. Provider business mailing address

9415 CROSS PLAINS CT
HOUSTON TX
77095-2797
US

V. Phone/Fax

Practice location:
  • Phone: 903-391-6767
  • Fax:
Mailing address:
  • Phone: 903-391-6767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number720718
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: