Healthcare Provider Details

I. General information

NPI: 1609956564
Provider Name (Legal Business Name): LARRY S FREEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 N COMMERCIAL ST SUITE 1360
BELLINGHAM WA
98225-4446
US

IV. Provider business mailing address

119 N COMMERCIAL ST SUITE 1360
BELLINGHAM WA
98225-4446
US

V. Phone/Fax

Practice location:
  • Phone: 360-752-5527
  • Fax: 360-752-5543
Mailing address:
  • Phone: 360-752-5527
  • Fax: 360-752-5543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD00016788
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1430602
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: