Healthcare Provider Details

I. General information

NPI: 1821761008
Provider Name (Legal Business Name): MADISON ELIZABETH FREEMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 BILL OWENS PKWY
LONGVIEW TX
75604-6210
US

IV. Provider business mailing address

1100 MCCANN ROAD APARTMENT H201
LONGVIEW TX
75601
US

V. Phone/Fax

Practice location:
  • Phone: 903-247-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14609
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: