Healthcare Provider Details

I. General information

NPI: 1821107756
Provider Name (Legal Business Name): MARK ALLEN FREEBORN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12039 NE 128TH ST STE 500
KIRKLAND WA
98034-3029
US

IV. Provider business mailing address

805 MADISON STREET SUITE 901
SEATTLE WA
98104-1172
US

V. Phone/Fax

Practice location:
  • Phone: 425-899-4809
  • Fax: 425-899-4811
Mailing address:
  • Phone: 206-264-8100
  • Fax: 206-264-8689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberML20007796
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberMD60002211
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: