MEDICARE: DR. TANDY RICE FREEMAN III M.D.

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	174400000X	Specialist	G8114	TX

General Provider Information

NPI Number	:	1730137225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TANDY RICE FREEMAN III M.D.

Provider Business Mailing Address
First Line	:	25 HIGHLAND PARK VLG
Second Line	:	SUITE 100 BOX 391
City	:	DALLAS
State	:	TX
Zip	:	75205-2789
Country	:	US
Telephone Number	:	469-718-0900
Fax Number	:	469-802-8560

Provider Business Practice Location Address
First Line	:	1015 N CARROLL AVE
Second Line	:	SUITE 103
City	:	DALLAS
State	:	TX
Zip	:	75204-6613
Country	:	US
Telephone Number	:	469-718-0900
Fax Number	:	469-802-8560

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	06/08/2016

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