MEDICARE: DR. JONATHAN M FREUDMAN MD

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	207R00000X	Internal Medicine Physician	G42881	CA

General Provider Information

NPI Number	:	1851331094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN M FREUDMAN MD

Provider Business Mailing Address
First Line	:	32 RIVER OAKS RD
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-1036
Country	:	US
Telephone Number	:	415-456-1652
Fax Number	:	415-532-3250

Provider Business Practice Location Address
First Line	:	1010 B ST
Second Line	:	SUITE 208
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-2922
Country	:	US
Telephone Number	:	415-456-1652
Fax Number	:

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	08/21/2012

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