Healthcare Provider Details

I. General information

NPI: 1376720326
Provider Name (Legal Business Name): ANDREW LEIGH FREEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY HOSPITAL 50 NORTH MEDICAL DRIVE
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

609 MILTON AVE
SALT LAKE CITY UT
84105-2112
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2121
  • Fax:
Mailing address:
  • Phone: 801-647-5107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number6360341-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number6360341-1205
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number6360341-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: