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General NPI Number Information
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NPI Number | 1902228737
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Entity Type | Organization
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Legal Business Name | MARK E FREEMAN M.D. PC
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Dates
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Enumeration Date | 01/14/2014
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Last Update Date | 01/14/2014
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Provider Practice Location Address
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Address Line | 3760 WASHINGTON PARKWAY
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City | IDAHO FALLS
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State | ID
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Zip | 83404
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Country | US
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Telephone | 208-881-5351
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Fax |
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Provider Business Mailing Address
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Address Line | 3760 WASHINGTON PARKWAY
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City | IDAHO FALLS
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State | ID
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Zip | 83404
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Country | US
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Telephone | 208-881-5351
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK E FREEMAN
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Credential | M.D.
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Telephone | 208-881-5351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | M10224
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License Number State | ID
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