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General NPI Number Information
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NPI Number | 1306094552
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Entity Type | Organization
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Legal Business Name | FREED PLASTIC SURGERY, A MEDICAL CORPORATION
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Dates
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Enumeration Date | 08/29/2008
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Last Update Date | 08/29/2008
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Provider Practice Location Address
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Address Line | 3180 BELL RD SUITE 200
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City | AUBURN
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State | CA
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Zip | 95603-9200
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Country | US
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Telephone | 530-885-4151
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Fax | 530-885-4131
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Provider Business Mailing Address
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Address Line | 3180 BELL RD SUITE 200
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City | AUBURN
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State | CA
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Zip | 95603-9200
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Country | US
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Telephone | 530-885-4151
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Fax | 530-885-4131
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Authorized Official
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Title or Position | SURGEON/OWNER
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Name | DR. JONATHAN R FREED
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Credential | M.D.
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Telephone | 530-885-4151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | G072375
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License Number State | CA
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