MEDICARE: DOUGLAS HALL FREER 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	207Q00000X	Family Medicine Physician	C41966	CA

General Provider Information

NPI Number	:	1922163807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS HALL FREER MD

Provider Business Mailing Address
First Line	:	US MARINE CORPS FORCES COMMAND
Second Line	:	HEALTH SERVICES SUPPORT, 1468 INGRAM ST
City	:	NORFOLK
State	:	VA
Zip	:	23551-2596
Country	:	US
Telephone Number	:	757-836-1685
Fax Number	:

Provider Business Practice Location Address
First Line	:	US MARINE CORPS FORCES COMMAND
Second Line	:	HEALTH SERVICES SUPPORT, 1468 INGRAM ST
City	:	NORFOLK
State	:	VA
Zip	:	23551-2596
Country	:	US
Telephone Number	:	757-836-1685
Fax Number	:

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

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	07/08/2007

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