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General NPI Number Information
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NPI Number | 1245404524
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Entity Type | Individual
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Provider Name | BRUCE MICHAEL FREEDMAN DPM
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Gender | Male
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 6719 GOVERNOR GC PEERY HWY STE 1900
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City | RICHLANDS
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State | VA
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Zip | 24641-0349
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Country | US
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Telephone | 276-964-9633
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1304
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City | RICHLANDS
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State | VA
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Zip | 24641-1304
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Country | US
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Telephone | 276-964-9633
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 351
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 351
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License Number State | VA
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