Healthcare Provider Details

I. General information

NPI: 1205825015
Provider Name (Legal Business Name): STUART VINCENT FREEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 FERNDALE AVENUE
RICHLAND WA
99354-1975
US

IV. Provider business mailing address

2320 FERNDALE AVENUE
RICHLAND WA
99354-1975
US

V. Phone/Fax

Practice location:
  • Phone: 509-375-5575
  • Fax:
Mailing address:
  • Phone: 509-375-5575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00015598
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: