Healthcare Provider Details

I. General information

NPI: 1811964695
Provider Name (Legal Business Name): JAMES PHILLIP FREESTONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 N 400 W C-12
OREM UT
84057-1909
US

IV. Provider business mailing address

171 N 400 W C-12
OREM UT
84057-1909
US

V. Phone/Fax

Practice location:
  • Phone: 801-224-4550
  • Fax: 801-224-1057
Mailing address:
  • Phone: 801-224-4550
  • Fax: 801-224-1057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number160549-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: