MEDICARE: MR. RONALD ANTHONY FREELAND C.R.N.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	674495	TX

General Provider Information

NPI Number	:	1174590442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD ANTHONY FREELAND C.R.N.A.

Provider Business Mailing Address
First Line	:	536 COUNTY ROAD 260
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-0501
Country	:	US
Telephone Number	:	936-615-7381
Fax Number	:	936-462-7004

Provider Business Practice Location Address
First Line	:	1204 N MOUND ST
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75961-4027
Country	:	US
Telephone Number	:	936-564-4611
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2006
Last Update Date	:	10/10/2014

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